UPMC for Life HMO Rx Choice (HMO)
$3.90 /month
Monthly Premium
Among the lowest-premium plans in 2026
$175.00
Annual Deductible
1,081
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 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 2 | $0.00 | Details |
| 2 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Jardiance Empagliflozin | Brand | Tier 3 | 0.3% coinsurance | Details |
| 4 | NOVOLOG insulin aspart | Brand | Tier 3 | 0.3% coinsurance | Details |
| 5 | Fluphenazine Hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 6 | Atomoxetine | Brand | Tier 4 | 0.5% coinsurance | Details |
| 7 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.5% coinsurance | Details |
| 9 | RYDAPT | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | ISENTRESS RALTEGRAVIR | Brand | Tier 3 | 0.3% coinsurance | Details |
| 11 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 12 | Diltiazem Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 13 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 15 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Diazepam Intensol | Brand | Tier 3 | 0.3% coinsurance | Details |
| 17 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Tacrolimus | Brand | Tier 2 | $0.00 | Details |
Showing 20 of 1,081 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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