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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H5425-126 Cross-check on Medicare.gov →

Sutter Senior Advantage, a SCAN Medicare Plan (HMO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$250.00 Annual Deductible
1,056 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 Cobenfy xanomeline and trospium chloride Brand Tier 4 0.4% coinsurance Details
2 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 2 $0.00 Details
3 Fiasp insulin aspart injection Brand Tier 3 $42.00 Details
4 Dicloxacillin Sodium Brand Tier 2 $0.00 Details
5 Cobenfy xanomeline and trospium chloride Brand Tier 4 0.4% coinsurance Details
6 FENTANYL Brand Tier 3 $42.00 Details
7 SOMAVERT pegvisomant Brand Tier 5 0.3% coinsurance Details
8 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
9 Pioglitazone Brand Tier 1 $0.00 Details
10 PODOFILOX Brand Tier 2 $0.00 Details
11 Xalkori CRIZOTINIB Brand Tier 5 0.3% coinsurance Details
12 RETEVMO selpercatinib Brand Tier 5 0.3% coinsurance Details
13 Talzenna talazoparib Brand Tier 5 0.3% coinsurance Details
14 DELSTRIGO doravirine, lamivudine, and tenofovir disoproxil fumarate Brand Tier 5 0.3% coinsurance Details
15 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 3 $42.00 Details
16 Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate Brand Tier 5 0.3% coinsurance Details
17 Dupixent Dupilumab Brand Tier 5 0.3% coinsurance Details
18 Xtandi enzalutamide Brand Tier 5 0.3% coinsurance Details
19 Haloperidol Brand Tier 2 $0.00 Details
20 Lenalidomide Brand Tier 5 0.3% coinsurance Details

Showing 20 of 1,056 covered drugs.

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States Served (1)

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

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