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Verified against CMS.gov · on Jul 1, 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 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $2.00 Details
2 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $2.00 Details
3 Amoxicillin and Clavulanate Potassium Brand Tier 2 $8.00 Details
4 VERQUVO vericiguat Brand Tier 4 0.3% coinsurance Details
5 Ampicillin Brand Tier 2 $8.00 Details
6 Fiasp insulin aspart injection Brand Tier 3 0.2% coinsurance Details
7 PIQRAY alpelisib Brand Tier 5 0.3% coinsurance Details
8 Potassium Chloride Brand Tier 2 $8.00 Details
9 Chlorhexidine Gluconate Brand Tier 2 $8.00 Details
10 Dicloxacillin Sodium Brand Tier 2 $8.00 Details
11 KISQALI ribociclib Brand Tier 5 0.3% coinsurance Details
12 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 3 0.2% coinsurance Details
13 Nitroglycerin nitroglycerin Brand Tier 2 $8.00 Details
14 Jardiance Empagliflozin Brand Tier 3 0.2% coinsurance Details
15 Haloperidol Brand Tier 2 $8.00 Details
16 Pioglitazone Brand Tier 1 $2.00 Details
17 Mekinist trametinib Brand Tier 5 0.3% coinsurance Details
18 Dicyclomine Hydrochloride Brand Tier 2 $8.00 Details
19 KISQALI ribociclib Brand Tier 5 0.3% coinsurance Details
20 Lupron Depot leuprolide acetate Brand Tier 5 0.3% coinsurance Details

Showing 20 of 978 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

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

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