Personal Choice 65 Achieve Rx (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$375.00
Annual Deductible
973
Drugs Covered
1
States Served
Top Covered Drugs
Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.
| # | Drug Name | Type | Tier | 30-Day Copay | |
|---|---|---|---|---|---|
| 1 | Trelegy Ellipta fluticasone furoate, umeclidinium bromide and vilanterol trifenatate | Brand | Tier 3 | 0.3% coinsurance | Details |
| 2 | ZOLINZA vorinostat | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | Nortriptyline Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 5 | Nefazodone Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 6 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 2 | $0.00 | Details |
| 7 | Ampicillin | Brand | Tier 2 | $0.00 | Details |
| 8 | Risperidone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Fluphenazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | Clozapine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | Warfarin Sodium | Brand | Tier 2 | $0.00 | Details |
| 12 | Metoclopramide | Brand | Tier 2 | $0.00 | Details |
| 13 | Leucovorin Calcium | Brand | Tier 3 | 0.3% coinsurance | Details |
| 14 | COARTEM artemether and lumefantrine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 15 | RYDAPT | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent | Brand | Tier 4 | 0.3% coinsurance | Details |
| 17 | PREVYMIS LETERMOVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Dexamethasone | Brand | Tier 2 | $0.00 | Details |
| 19 | Nitroglycerin nitroglycerin | Brand | Tier 3 | 0.3% coinsurance | Details |
| 20 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
Showing 20 of 973 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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