UPMC for Life PPO Rx Enhanced (PPO)
$140.00 /month
Monthly Premium
$0.00
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 | Imatinib Mesylate | Brand | Tier 2 | $0.00 | Details |
| 2 | Phenobarbital | Brand | Tier 2 | $0.00 | Details |
| 3 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 4 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | PENBRAYA meningococcal groups a, b, c, w, and y vaccine | Brand | Tier 1 | $0.00 | Details |
| 6 | Gentamicin Sulfate | Brand | Tier 4 | 0.5% coinsurance | Details |
| 7 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 8 | Chlorhexidine Gluconate | Brand | Tier 2 | $0.00 | Details |
| 9 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Pilocarpine Hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 11 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.5% coinsurance | Details |
| 12 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 2 | $0.00 | Details |
| 13 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Jardiance Empagliflozin | Brand | Tier 3 | 0.3% coinsurance | Details |
| 15 | NOVOLOG insulin aspart | Brand | Tier 3 | 0.3% coinsurance | Details |
| 16 | Fluphenazine Hydrochloride | Brand | Tier 3 | 0.3% coinsurance | Details |
| 17 | Atomoxetine | Brand | Tier 4 | 0.5% coinsurance | Details |
| 18 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.5% coinsurance | Details |
| 20 | RYDAPT | Brand | Tier 5 | 0.3% coinsurance | 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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