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Verified against CMS.gov · on April 2026 Plan ID: H9387-001 Cross-check on Medicare.gov →

Wellcare Simple Open (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
929 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 BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN Brand Tier 6 $0.00 Details
2 Trumenba meningococcal group B vaccine Brand Tier 6 $0.00 Details
3 Venclexta Venetoclax Brand Tier 3 0.3% coinsurance Details
4 NITROGLYCERIN nitroglycerin Brand Tier 4 0.3% coinsurance Details
5 Medroxyprogesterone Acetate Brand Tier 1 $0.00 Details
6 Dicloxacillin Sodium Brand Tier 2 $0.00 Details
7 Cobenfy xanomeline and trospium chloride Brand Tier 5 0.3% coinsurance Details
8 Amoxapine Brand Tier 4 0.3% coinsurance Details
9 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 2 $0.00 Details
10 VAQTA hepatitis A vaccine, inactivated Brand Tier 6 $0.00 Details
11 Fluvoxamine maleate Brand Tier 2 $0.00 Details
12 Linzess linaclotide Brand Tier 4 0.3% coinsurance Details
13 NOVOLOG insulin aspart Brand Tier 3 0.3% coinsurance Details
14 Ipratropium Bromide Brand Tier 2 $0.00 Details
15 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
16 Fluphenazine Hydrochloride Brand Tier 2 $0.00 Details
17 RETEVMO selpercatinib Brand Tier 5 0.3% coinsurance Details
18 SCEMBLIX asciminib Brand Tier 5 0.3% coinsurance Details
19 Bromocriptine mesylate Brand Tier 2 $0.00 Details
20 PIFELTRO doravirine Brand Tier 5 0.3% coinsurance Details

Showing 20 of 929 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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