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Verified against CMS.gov · on April 2026 Plan ID: H4875-020 Cross-check on Medicare.gov →

PriorityMedicare Edge (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$200.00 Annual Deductible
978 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 Nefazodone Hydrochloride Brand Tier 4 0.3% coinsurance Details
2 Rufinamide Brand Tier 4 0.3% coinsurance Details
3 PREVYMIS LETERMOVIR Brand Tier 5 0.3% coinsurance Details
4 CRESEMBA isavuconazonium sulfate Brand Tier 5 0.3% coinsurance Details
5 ZEJULA niraparib Brand Tier 5 0.3% coinsurance Details
6 Nefazodone Hydrochloride Brand Tier 4 0.3% coinsurance Details
7 Tafinlar dabrafenib Brand Tier 5 0.3% coinsurance Details
8 FENTANYL Brand Tier 4 0.3% coinsurance Details
9 bexarotene Brand Tier 5 0.3% coinsurance Details
10 LACTULOSE Lactulose Brand Tier 2 $8.00 Details
11 Isoniazid Brand Tier 2 $8.00 Details
12 Prograf Tacrolimus Brand Tier 4 0.3% coinsurance Details
13 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 0.2% coinsurance Details
14 Diazepam Intensol Brand Tier 4 0.3% coinsurance Details
15 Ceftriaxone Sodium Brand Tier 4 0.3% coinsurance Details
16 Talzenna talazoparib Brand Tier 5 0.3% coinsurance Details
17 Calcipotriene Brand Tier 3 0.2% coinsurance Details
18 Cefuroxime Brand Tier 4 0.3% coinsurance Details
19 Sulfasalazine Brand Tier 2 $8.00 Details
20 BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN Brand Tier 3 0.2% coinsurance Details

Showing 20 of 978 covered drugs.

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States Served (1)

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

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