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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3664-017 Cross-check on Medicare.gov →

PrimeTime Health Plan Plus (HMO-POS)

Plan Year 2026
$36.00 /month
Monthly Premium
$0.00 Annual Deductible
1,050 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 Ciprofloxacin Brand Tier 2 $0.00 Details
2 RETEVMO selpercatinib Brand Tier 5 0.3% coinsurance Details
3 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
4 Kaletra Lopinavir and Ritonavir Brand Tier 4 0.5% coinsurance Details
5 Nitroglycerin nitroglycerin Brand Tier 2 $0.00 Details
6 Atomoxetine Brand Tier 3 0.2% coinsurance Details
7 Clozapine Brand Tier 4 0.5% coinsurance Details
8 ENTRESTO Sacubitril and Valsartan Brand Tier 3 0.2% coinsurance Details
9 ELIQUIS 30-Day Starter Pack 30-Day Starter Pack apixaban Brand Tier 3 0.2% coinsurance Details
10 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 3 0.2% coinsurance Details
11 Ampicillin and Sulbactam Brand Tier 4 0.5% coinsurance Details
12 Imatinib Mesylate Brand Tier 4 0.5% coinsurance Details
13 Buspirone Hydrochloride Brand Tier 2 $0.00 Details
14 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 0.2% coinsurance Details
15 Diltiazem Hydrochloride Brand Tier 2 $0.00 Details
16 Nefazodone Hydrochloride Brand Tier 4 0.5% coinsurance Details
17 CALQUENCE acalabrutinib Brand Tier 5 0.3% coinsurance Details
18 TAGRISSO osimertinib Brand Tier 5 0.3% coinsurance Details
19 POSACONAZOLE Posaconazole Brand Tier 5 0.3% coinsurance Details
20 Fludrocortisone Acetate FLUDROCORTISONE ACETATE Brand Tier 2 $0.00 Details

Showing 20 of 1,050 covered drugs.

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States Served (1)

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

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