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Medications
Levomilnacipran (Fetzima) — plans on this site that list it on Tier 3
108 plans published on this site list this drug on Tier 3, grouped by company. Plans are sold by county — the service area under each plan shows where it is offered.
AHF
1 plan on this site
- PHP (HMO C-SNP) — Offered in CA: Los Angeles
Banner Medicare Advantage
1 plan on this site
- Banner Medicare Advantage Prime (HMO) — Offered in AZ: Maricopa
Blue Cross and Blue Shield of Louisiana
8 plans on this site
- Blue adVantage Classic (HMO-POS) — Offered in LA: 21 counties
- Blue adVantage Dual Plus (HMO-POS D-SNP) — Offered in LA: 64 counties
- Blue adVantage Giveback (HMO-POS) — Offered in LA: 31 counties
- Blue adVantage Liberty (PPO) — Offered in LA: 63 counties
- Blue adVantage Platinum (HMO-POS) — Offered in LA: 48 counties
- Blue adVantage Premier (PPO) — Offered in LA: 64 counties
- Blue adVantage Reliance (HMO-POS) — Offered in LA: 47 counties
- Blue adVantage Thrive (PPO) — Offered in LA: 31 counties
BlueCare Plus Tennessee
3 plans on this site
- BlueCare Plus (HMO D-SNP) — Offered in TN: 95 counties
- BlueCare Plus Choice (HMO D-SNP) — Offered in TN: 95 counties
- BlueCare Plus Select (HMO D-SNP) — Offered in TN: 95 counties
BlueCross BlueShield of Tennessee
8 plans on this site
- BlueAdvantage Diamond (PPO) — Offered in TN: 46 counties
- BlueAdvantage Emerald (PPO) — Offered in TN: 21 counties
- BlueAdvantage Extra (PPO) — Offered in GA: Catoosa, Dade, Walker; TN: 95 counties
- BlueAdvantage Garnet (PPO) — Offered in TN: 22 counties
- BlueAdvantage Ruby (PPO) — Offered in TN: 41 counties
- BlueAdvantage Sapphire (PPO) — Offered in TN: 22 counties
- BlueAdvantage Total Heart and Diabetes (PPO C-SNP) — Offered in GA: Catoosa, Dade, Walker; TN: 49 counties
- BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) — Offered in TN: 95 counties
Essence Healthcare
7 plans on this site
- Essence Advantage (HMO) — Offered in IN: Clark, Crawford, Floyd, Harrison, Jefferson, Ripley, Scott, Switzerland, Washington; KY: 21 counties
- Essence Advantage Choice (PPO) — Offered in IN: Clark, Crawford, Floyd, Harrison, Jefferson, Ripley, Scott, Switzerland, Washington; KY: 21 counties
- Essence Advantage Choice Plus (PPO) — Offered in IL: Cook, DuPage, Will
- Essence Advantage Plus (HMO) — Offered in IL: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, St. Clair, Washington; MO: 11 counties
- Essence Advantage Premier Plus (PPO) — Offered in IL: Bond, Clinton, Jersey, Macoupin, Madison, Monroe, St. Clair; MO: 11 counties
- Essence Advantage Prime (HMO) — Offered in MO: Chariton, Maries, Miller, Morgan, Osage, Randolph, Reynolds
- Essence Advantage Select (HMO) — Offered in IL: Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, St. Clair, Washington; MO: 13 counties
Freedom Health, Inc.
10 plans on this site
- Freedom Medi-Medi Full (HMO D-SNP) — Offered in FL: Brevard
- Freedom Medi-Medi Partial (HMO D-SNP) — Offered in FL: 24 counties
- Freedom Medicare Plan Rx (HMO) — Offered in FL: Brevard, Charlotte, Lee, Pinellas, Volusia
- Freedom Máximo (HMO-POS) — Offered in FL: Orange, Osceola, Seminole
- Freedom Platinum Plan Rx (HMO) — Offered in FL: Charlotte, Collier, Lee, Manatee, Sarasota
- Freedom Platinum Rewards Plan Rx (HMO) — Offered in FL: Orange, Osceola, Seminole, Volusia
- Freedom VIP Care (HMO C-SNP) — Offered in FL: 16 counties
- Freedom VIP Rewards (HMO C-SNP) — Offered in FL: Brevard, Indian River, Martin, St. Lucie
- Freedom VIP Savings (HMO C-SNP) — Offered in FL: 16 counties
- Freedom VIP Savings COPD (HMO C-SNP) — Offered in FL: 16 counties
HAP CareSource MI Coordinated Health
1 plan on this site
- HAP CareSource MI Coordinated Health (HMO D-SNP) — Offered in MI: Macomb, Wayne
HealthSun Health Plans, Inc.
6 plans on this site
- HealthSun HealthAdvantage Plan (HMO) — Offered in FL: Miami-Dade
- HealthSun HealthAdvantage Plus (HMO) — Offered in FL: Miami-Dade
- HealthSun MediMax (HMO) — Offered in FL: Broward, Miami-Dade
- HealthSun MediSun Extra (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
- HealthSun MediSun Full Dual Extra (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
- HealthSun VitalCare (HMO C-SNP) — Offered in FL: Broward, Miami-Dade
HealthTeam Advantage
4 plans on this site
- HealthTeam Advantage Plan I (PPO) — Offered in NC: 12 counties
- HealthTeam Advantage Plan II (PPO) — Offered in NC: 12 counties
- HealthTeam Advantage Thrive Plan (HMO) — Offered in NC: Alamance, Davidson, Davie, Forsyth, Guilford, Randolph, Rockingham
- HealthTeam Advantage Vitality Plan (PPO) — Offered in NC: 33 counties
Leon Health, Inc.
4 plans on this site
- Leon MediDual (HMO D-SNP) — Offered in FL: Miami-Dade
- Leon MediExtra (HMO) — Offered in FL: Miami-Dade
- Leon MediMax (HMO D-SNP) — Offered in FL: Miami-Dade
- Leon MediMore (HMO) — Offered in FL: Miami-Dade
MCS Classicare
16 plans on this site
- MCS Classicare Efectivo (HMO) — Offered in PR: 78 counties
- MCS Classicare En Tu Hogar (HMO) — Offered in PR: 78 counties
- MCS Classicare Essential (HMO-POS) — Offered in PR: 78 counties
- MCS Classicare Estrella (HMO) — Offered in PR: 37 counties
- MCS Classicare Excede (HMO) — Offered in PR: 17 counties
- MCS Classicare Firme (HMO) — Offered in PR: 39 counties
- MCS Classicare Hero (HMO) — Offered in PR: 78 counties
- MCS Classicare InteliCare (HMO) — Offered in PR: 78 counties
- MCS Classicare Platino 202 (HMO D-SNP) — Offered in PR: 78 counties
- MCS Classicare Platino Ideal (HMO D-SNP) — Offered in PR: 78 counties
- MCS Classicare Platino Maximo (HMO D-SNP) — Offered in PR: 44 counties
- MCS Classicare Platino Progreso (HMO D-SNP) — Offered in PR: 78 counties
- MCS Classicare Platino Total (HMO D-SNP) — Offered in PR: 78 counties
- MCS Classicare Platino Ultra (HMO D-SNP) — Offered in PR: 39 counties
- MCS Classicare Primero (HMO C-SNP) — Offered in PR: 78 counties
- MCS Classicare RxMax (HMO) — Offered in PR: 78 counties
Medica
1 plan on this site
- Medica DUAL Solution (HMO D-SNP) — Offered in MN: 54 counties
Medicare y Mucho Mas (MMM)
16 plans on this site
- MMM Balance (HMO-POS) — Offered in PR: 50 counties
- MMM Combo Platino (HMO D-SNP) — Offered in PR: 78 counties
- MMM Deluxe (HMO-POS) — Offered in PR: 78 counties
- MMM Diamante Platino (HMO D-SNP) — Offered in PR: 78 counties
- MMM Dorado Platino (HMO D-SNP) — Offered in PR: 13 counties
- MMM Elite (HMO-POS) — Offered in PR: 78 counties
- MMM Estela (HMO-POS) — Offered in PR: 56 counties
- MMM Grandioso (HMO-POS) — Offered in PR: 78 counties
- MMM Mega Flex (HMO-POS) — Offered in PR: 78 counties
- MMM Plenitud (HMO-POS) — Offered in PR: 78 counties
- MMM Preciso Platino (HMO D-SNP) — Offered in PR: 42 counties
- MMM Relax Platino (HMO D-SNP) — Offered in PR: 38 counties
- MMM Supremo (HMO C-SNP) — Offered in PR: 78 counties
- MMM Valioso (HMO-POS) — Offered in PR: 78 counties
- PMC Max (HMO-POS) — Offered in PR: 78 counties
- PMC Premier Platino (HMO D-SNP) — Offered in PR: 78 counties
Optimum HealthCare, Inc.
11 plans on this site
- Optimum Diamond (HMO C-SNP) — Offered in FL: Citrus, Hernando, Hillsborough, Pasco, Pinellas
- Optimum Diamond Rewards (HMO C-SNP) — Offered in FL: Citrus, Hernando, Hillsborough, Pasco, Pinellas
- Optimum Diamond Rewards COPD (HMO C-SNP) — Offered in FL: Citrus, Hernando, Hillsborough, Pasco, Pinellas
- Optimum Diamond Savings (HMO C-SNP) — Offered in FL: 18 counties
- Optimum Diamond Savings COPD (HMO C-SNP) — Offered in FL: 14 counties
- Optimum Emerald Full (HMO D-SNP) — Offered in FL: Collier
- Optimum Emerald Partial (HMO D-SNP) — Offered in FL: 24 counties
- Optimum Gold Plan (HMO) — Offered in FL: Citrus, Polk, Sarasota
- Optimum Gold Plus Plan (HMO) — Offered in FL: Citrus, Hernando
- Optimum Gold Rewards Plan (HMO) — Offered in FL: Broward, Citrus, Hernando, Hillsborough, Pasco, Pinellas
- Optimum Platinum Plan (HMO) — Offered in FL: Broward, Citrus, Hernando, Hillsborough, Pasco, Pinellas
Sentara Medicare
2 plans on this site
- Sentara Community Complete (HMO D-SNP) — Offered in VA: 133 counties
- Sentara Community Complete Select (HMO D-SNP) — Offered in VA: 133 counties
Simply Healthcare Plans, Inc.
2 plans on this site
- Simply Complete Platinum (HMO D-SNP) — Offered in FL: 24 counties
- Simply Integrated Platinum (HMO D-SNP) — Offered in FL: 24 counties
The Health Plan
4 plans on this site
- The Health Plan SecureCare - Option II (HMO) — Offered in OH: 69 counties
- The Health Plan SecureCare SNP (HMO D-SNP) — Offered in WV: 55 counties
- The Health Plan SecureChoice Optimum (PPO) — Offered in OH: 77 counties
- The Health Plan SecureChoice Reliance (PPO) — Offered in WV: 55 counties
Upper Peninsula Health Plan (UPHP) MI Coordinated Health
1 plan on this site
- Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) — Offered in MI: 15 counties
VNS Health Medicare
2 plans on this site
- VNS Health EasyCare Plus (HMO D-SNP) — Offered in NY: 20 counties
- VNS Health Total (HMO D-SNP) — Offered in NY: 20 counties
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage.
Source: CMS Prescription Drug Plan Formulary data + this site's published plan records · List built 2026-11-08
