Premier by Ultimate (HMO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00
Annual Deductible
962
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 | Tiagabine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 2 | Amoxicillin and Clavulanate Potassium | Brand | Tier 2 | $0.00 | Details |
| 3 | Propranolol Hydrochloride propranolol hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 2 | $0.00 | Details |
| 5 | Perphenazine perphenazine | Brand | Tier 4 | $0.00 | Details |
| 6 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 7 | Linzess linaclotide | Brand | Tier 3 | $0.00 | Details |
| 8 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | $0.00 | Details |
| 9 | Ciprofloxacin in Dextrose ciprofloxacin | Brand | Tier 3 | $0.00 | Details |
| 10 | TRETINOIN tretinoin | Brand | Tier 4 | $0.00 | Details |
| 11 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 12 | ETHOSUXIMIDE | Brand | Tier 3 | $0.00 | Details |
| 13 | ENTRESTO Sacubitril and Valsartan | Brand | Tier 3 | $0.00 | Details |
| 14 | Calcipotriene | Brand | Tier 3 | $0.00 | Details |
| 15 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 16 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 17 | NOVOLOG insulin aspart | Brand | Tier 3 | $0.00 | Details |
| 18 | Clozapine | Brand | Tier 4 | $0.00 | Details |
| 19 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | $0.00 | Details |
| 20 | Pilocarpine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
Showing 20 of 962 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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