Providence Medicare Extra Part B Only + Rx (HMO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00
Annual Deductible
992
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 | Imatinib Mesylate | Brand | Tier 3 | $40.00 | Details |
| 2 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Warfarin Sodium | Brand | Tier 1 | $1.00 | Details |
| 4 | TAGRISSO osimertinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Mifepristone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | Brand | Tier 3 | $40.00 | Details |
| 7 | Nortriptyline Hydrochloride | Brand | Tier 3 | $40.00 | Details |
| 8 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $12.00 | Details |
| 9 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | $40.00 | Details |
| 10 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Fiasp insulin aspart injection | Brand | Tier 3 | $40.00 | Details |
| 13 | Baclofen | Brand | Tier 2 | $12.00 | Details |
| 14 | Warfarin Sodium | Brand | Tier 1 | $1.00 | Details |
| 15 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | $90.00 | Details |
| 16 | Pilocarpine Hydrochloride | Brand | Tier 4 | $90.00 | Details |
| 17 | Warfarin Sodium | Brand | Tier 1 | $1.00 | Details |
| 18 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 3 | $40.00 | Details |
| 20 | Nicotrol nicotine | Brand | Tier 4 | $90.00 | Details |
Showing 20 of 992 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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