Personal Choice 65 Plus Rx (PPO)
$81.20 /month
Monthly Premium
$0.00
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 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | SOMAVERT pegvisomant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Loxapine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 4 | Warfarin Sodium | Brand | Tier 2 | $0.00 | Details |
| 5 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 6 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Midodrine Hydrochloride midodrine hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 9 | Ceftriaxone Sodium | Brand | Tier 2 | $0.00 | Details |
| 10 | Calcipotriene | Brand | Tier 3 | 0.3% coinsurance | Details |
| 11 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 1 | $0.00 | Details |
| 12 | Isosorbide Dinitrate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 13 | MERCAPTOPURINE | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Linzess linaclotide | Brand | Tier 3 | 0.3% coinsurance | Details |
| 15 | Nefazodone Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 16 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | TRUQAP capivasertib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Fluphenazine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 19 | Venclexta Venetoclax | Brand | Tier 3 | 0.3% coinsurance | Details |
| 20 | Prochlorperazine | Brand | Tier 4 | 0.4% 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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