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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3204-013 Cross-check on Medicare.gov →

Presbyterian Dual Plus (HMO D-SNP)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$550.00 Annual Deductible
938 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 Ibrance palbociclib Brand Tier 5 $0.00 Details
2 bexarotene Brand Tier 5 $0.00 Details
3 NOVOLOG insulin aspart Brand Tier 3 $0.00 Details
4 Nortriptyline Hydrochloride Brand Tier 3 $0.00 Details
5 Fluphenazine Hydrochloride Brand Tier 4 $0.00 Details
6 Nitroglycerin nitroglycerin Brand Tier 2 $0.00 Details
7 Chlorpromazine Hydrochloride Brand Tier 4 $0.00 Details
8 Ciprofloxacin Brand Tier 2 $0.00 Details
9 Diltiazem Hydrochloride Brand Tier 2 $0.00 Details
10 Isosorbide Dinitrate Brand Tier 2 $0.00 Details
11 Amoxapine Brand Tier 3 $0.00 Details
12 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 3 $0.00 Details
13 Linzess linaclotide Brand Tier 4 $0.00 Details
14 Phenobarbital Oral Solution Phenobarbital Oral Brand Tier 2 $0.00 Details
15 Dexamethasone Brand Tier 2 $0.00 Details
16 SCEMBLIX asciminib Brand Tier 5 $0.00 Details
17 Mefloquine Hydrochloride Brand Tier 2 $0.00 Details
18 Xtandi enzalutamide Brand Tier 5 $0.00 Details
19 EVOTAZ atazanavir and cobicistat Brand Tier 5 $0.00 Details
20 Mercaptopurine Brand Tier 2 $0.00 Details

Showing 20 of 938 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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