UPMC for Life HMO Deductible Rx (HMO)
$18.10 /month
Monthly Premium
Among the lowest-premium plans in 2026
$175.00
Annual Deductible
1,081
Drugs Covered
2
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 | Lupron Depot leuprolide acetate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 6 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Imatinib Mesylate | Brand | Tier 2 | $0.00 | Details |
| 8 | Phenobarbital | Brand | Tier 2 | $0.00 | Details |
| 9 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 10 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | PENBRAYA meningococcal groups a, b, c, w, and y vaccine | Brand | Tier 1 | $0.00 | Details |
| 12 | Gentamicin Sulfate | Brand | Tier 4 | 0.5% coinsurance | Details |
| 13 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 14 | Chlorhexidine Gluconate | Brand | Tier 2 | $0.00 | Details |
| 15 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Pilocarpine Hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 17 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.5% coinsurance | Details |
| 18 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 2 | $0.00 | Details |
| 19 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Jardiance Empagliflozin | Brand | Tier 3 | 0.3% coinsurance | Details |
Showing 20 of 1,081 covered drugs.
States Served (2)
This plan is available to Medicare beneficiaries in the following states.
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