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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H4005-004 Cross-check on Medicare.gov →

?ptimo Plus (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00 Annual Deductible
950 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 Amoxicillin Brand Tier 1 $0.00 Details
2 Dexamethasone Brand Tier 1 $0.00 Details
3 Vizimpro dacomitinib Brand Tier 5 0.3% coinsurance Details
4 Phenobarbital Brand Tier 2 $0.00 Details
5 Venclexta Venetoclax Brand Tier 3 $30.00 Details
6 Kaletra Lopinavir and Ritonavir Brand Tier 4 $50.00 Details
7 Valsartan valsartan Brand Tier 6 $0.00 Details
8 Propranolol Hydrochloride propranolol hydrochloride Brand Tier 2 $0.00 Details
9 Digoxin Brand Tier 2 $0.00 Details
10 VAQTA hepatitis A vaccine, inactivated Brand Tier 6 $0.00 Details
11 Dexamethasone Brand Tier 1 $0.00 Details
12 ELIQUIS 30-Day Starter Pack 30-Day Starter Pack apixaban Brand Tier 3 $30.00 Details
13 CALQUENCE acalabrutinib Brand Tier 5 0.3% coinsurance Details
14 Vizimpro dacomitinib Brand Tier 5 0.3% coinsurance Details
15 M-M-R II measles, mumps, and rubella virus vaccine live Brand Tier 6 $0.00 Details
16 Clotrimazole clotrimazole Brand Tier 2 $0.00 Details
17 Tiagabine Hydrochloride Brand Tier 2 $0.00 Details
18 Ibrance palbociclib Brand Tier 5 0.3% coinsurance Details
19 WELIREG belzutifan Brand Tier 5 0.3% coinsurance Details
20 Nefazodone Hydrochloride Brand Tier 2 $0.00 Details

Showing 20 of 950 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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