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Verified against CMS.gov · on July 2026 Plan ID: H4676-002 Cross-check on Medicare.gov →

Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
1,089 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 Nitroglycerin nitroglycerin Brand Tier 2 $0.00 Details
2 Teflaro ceftaroline fosamil Brand Tier 5 $0.00 Details
3 BOSULIF Bosutinib Brand Tier 5 $0.00 Details
4 Imatinib Mesylate Brand Tier 2 $0.00 Details
5 Spiriva Respimat tiotropium bromide inhalation spray Brand Tier 3 $0.00 Details
6 TAGRISSO osimertinib Brand Tier 5 $0.00 Details
7 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 6 $0.00 Details
8 Fluphenazine Hydrochloride Brand Tier 2 $0.00 Details
9 Fosamprenavir Calcium fosamprenavir calcium Brand Tier 5 $0.00 Details
10 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 $0.00 Details
11 Gentamicin Sulfate Brand Tier 1 $0.00 Details
12 Warfarin Sodium Brand Tier 1 $0.00 Details
13 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 2 $0.00 Details
14 Warfarin Sodium Brand Tier 1 $0.00 Details
15 Exemestane Brand Tier 2 $0.00 Details
16 Fiasp insulin aspart injection Brand Tier 3 $0.00 Details
17 CALQUENCE acalabrutinib Brand Tier 5 $0.00 Details
18 Chlorpromazine Hydrochloride Brand Tier 2 $0.00 Details
19 SCEMBLIX asciminib Brand Tier 5 $0.00 Details
20 Cyclosporine Modified Modified Cyclosporine Brand Tier 2 $0.00 Details

Showing 20 of 1,089 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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