UPMC for Life HMO Rx (HMO)
$33.70 /month
Monthly Premium
$0.00
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 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Diazepam Intensol | Brand | Tier 3 | 0.3% coinsurance | Details |
| 3 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Tacrolimus | Brand | Tier 2 | $0.00 | Details |
| 7 | DELSTRIGO doravirine, lamivudine, and tenofovir disoproxil fumarate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Omeprazole | Brand | Tier 2 | $0.00 | Details |
| 10 | Venlafaxine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 11 | BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN | Brand | Tier 1 | $0.00 | Details |
| 12 | Ciprofloxacin | Brand | Tier 2 | $0.00 | Details |
| 13 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 15 | Hydrochlorothiazide | Brand | Tier 1 | $0.00 | Details |
| 16 | FENTANYL | Brand | Tier 3 | 0.3% coinsurance | Details |
| 17 | Emtricitabine and Tenofovir Disoproxil Fumarate | Brand | Tier 4 | 0.5% coinsurance | Details |
| 18 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 1 | $0.00 | 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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