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Medications
Procarbazine (Matulane) — plans on this site that list it on Tier 4
30 plans published on this site list this drug on Tier 4, 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
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
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
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
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
