UPMC for Life PPO Rx Choice (PPO)
$25.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$400.00
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 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Venlafaxine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 3 | Probenecid | Brand | Tier 4 | 0.4% coinsurance | Details |
| 4 | Metoprolol Tartrate metoprolol tartrate | Brand | Tier 1 | $0.00 | Details |
| 5 | VARIVAX Varicella Virus Vaccine Live | Brand | Tier 1 | $0.00 | Details |
| 6 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 7 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $0.00 | Details |
| 9 | Lupron Depot leuprolide acetate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 13 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Imatinib Mesylate | Brand | Tier 2 | $0.00 | Details |
| 15 | Phenobarbital | Brand | Tier 2 | $0.00 | Details |
| 16 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 17 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | PENBRAYA meningococcal groups a, b, c, w, and y vaccine | Brand | Tier 1 | $0.00 | Details |
| 19 | Gentamicin Sulfate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 20 | Amoxicillin | 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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