Saint Alphonsus Health Plan Choice (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$250.00
Annual Deductible
994
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 | Mercaptopurine | Brand | Tier 3 | 0.3% coinsurance | Details |
| 2 | Dicloxacillin Sodium | Brand | Tier 3 | 0.3% coinsurance | Details |
| 3 | Loxapine | Brand | Tier 3 | 0.3% coinsurance | Details |
| 4 | Perphenazine perphenazine | Brand | Tier 3 | 0.3% coinsurance | Details |
| 5 | LACTULOSE Lactulose | Brand | Tier 2 | $6.00 | Details |
| 6 | Nortriptyline Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 7 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Scopolamine scopolamine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 9 | Spiriva Respimat tiotropium bromide inhalation spray | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Sulfasalazine | Brand | Tier 2 | $6.00 | Details |
| 15 | TRUQAP capivasertib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Methylphenidate Hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 18 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 19 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 1 | $0.00 | Details |
| 20 | Cefuroxime | Brand | Tier 3 | 0.3% coinsurance | Details |
Showing 20 of 994 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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