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Verified against CMS.gov · on April 2026 Plan ID: H4875-022 Cross-check on Medicare.gov →

PriorityMedicare Vital (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$450.00 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 SCEMBLIX asciminib Brand Tier 5 0.3% coinsurance Details
2 Venclexta Venetoclax Brand Tier 3 $42.00 Details
3 Dextrose and Sodium Chloride Brand Tier 4 0.3% coinsurance Details
4 INLYTA axitinib Brand Tier 5 0.3% coinsurance Details
5 WINREVAIR SOTATERCEPT-CSRK Brand Tier 5 0.3% coinsurance Details
6 Ofev nintedanib Brand Tier 5 0.3% coinsurance Details
7 WELIREG belzutifan Brand Tier 5 0.3% coinsurance Details
8 Nefazodone Hydrochloride Brand Tier 4 0.3% coinsurance Details
9 Rufinamide Brand Tier 4 0.3% coinsurance Details
10 PREVYMIS LETERMOVIR Brand Tier 5 0.3% coinsurance Details
11 CRESEMBA isavuconazonium sulfate Brand Tier 5 0.3% coinsurance Details
12 ZEJULA niraparib Brand Tier 5 0.3% coinsurance Details
13 Nefazodone Hydrochloride Brand Tier 4 0.3% coinsurance Details
14 Tafinlar dabrafenib Brand Tier 5 0.3% coinsurance Details
15 FENTANYL Brand Tier 4 0.3% coinsurance Details
16 bexarotene Brand Tier 5 0.3% coinsurance Details
17 LACTULOSE Lactulose Brand Tier 2 $10.00 Details
18 Isoniazid Brand Tier 2 $10.00 Details
19 Prograf Tacrolimus Brand Tier 4 0.3% coinsurance Details
20 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 $42.00 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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