Wellcare Simple Open (PPO)
$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 | Cilostazol | Brand | Tier 1 | $0.00 | Details |
| 2 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $0.00 | Details |
| 3 | Clonidine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 4 | Budesonide | Brand | Tier 4 | 0.4% coinsurance | Details |
| 5 | Gilotrif afatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 7 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Depo-SubQ Provera medroxyprogesterone acetate | Brand | Tier 3 | 0.3% coinsurance | Details |
| 9 | Chlorhexidine Gluconate | Brand | Tier 1 | $0.00 | Details |
| 10 | Gentamicin Sulfate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 11 | INLYTA axitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Rufinamide | Brand | Tier 2 | $0.00 | Details |
| 13 | DELSTRIGO doravirine, lamivudine, and tenofovir disoproxil fumarate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Amoxicillin and Clavulanate Potassium | Brand | Tier 2 | $0.00 | Details |
| 18 | Risperidone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | NOVOLOG insulin aspart | Brand | Tier 3 | 0.3% coinsurance | Details |
| 20 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 929 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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