2009 Medicare Part D Plan Formulary Information |
Windsor Rx (S2505-005-0)
Benefit Details
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The Windsor Rx (S2505-005-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 20 which includes: MS
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in MS cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL XR 200MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL XR 200MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROQUEL XR 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MS cover SEROQUEL XR 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SEROSTIM 4MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SEROSTIM 4MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SEROSTIM 5MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SEROSTIM 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SEROSTIM 6MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SEROSTIM 6MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MS cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HCL 20MG/ML CONCENTRATE ORAL ![Compare how all Medicare Part D PDP plans in MS cover SERTRALINE HCL 20MG/ML CONCENTRATE ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SERTRALINE HCL 25MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MS cover SERTRALINE HCL 25MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MS cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in MS cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SIMULECT 10MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SIMULECT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MS cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in MS cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MS cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MS cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MS cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | Q:60 /23Days |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in MS cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | Q:60 /23Days |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MS cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | Q:60 /23Days |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MS cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | Q:60 /23Days |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in MS cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in MS cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in MS cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in MS cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM POLYSTYRENE SULFONATE 15G/60ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in MS cover SODIUM POLYSTYRENE SULFONATE 15G/60ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SODIUM POLYSTYRENE SULFONATE 30G/120ML ENEMA ![Compare how all Medicare Part D PDP plans in MS cover SODIUM POLYSTYRENE SULFONATE 30G/120ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM POLYSTYRENE SULFONATE 50G/200ML ENEMA ![Compare how all Medicare Part D PDP plans in MS cover SODIUM POLYSTYRENE SULFONATE 50G/200ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in MS cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SOLODYN 135MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SOLODYN 135MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SOLODYN 45MG TABLET SR 24HR (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SOLODYN 45MG TABLET SR 24HR (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SOLODYN 90MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SOLODYN 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SOLTAMOX 10MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in MS cover SOLTAMOX 10MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
SOMATULINE DEPOT FOR INJECTION 120MG/0.5ML ![Compare how all Medicare Part D PDP plans in MS cover SOMATULINE DEPOT FOR INJECTION 120MG/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MS cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SOTALOL HCL 120MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 120MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOTALOL HCL 80MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL 80MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in MS cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in MS cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in MS cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in MS cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:28 /21Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in MS cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SPS 15GM/60ML SUSPENSION ![Compare how all Medicare Part D PDP plans in MS cover SPS 15GM/60ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in MS cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SSD AF 1% CREAM ![Compare how all Medicare Part D PDP plans in MS cover SSD AF 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
STARLIX 120MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover STARLIX 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
STARLIX 60MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover STARLIX 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
STERILE GAUZE PADS 2X 2 ![Compare how all Medicare Part D PDP plans in MS cover STERILE GAUZE PADS 2X 2.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in MS cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | S |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
STROMECTOL 6MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover STROMECTOL 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
SUCRAID 8500UNITS/ML SOLUTION ![Compare how all Medicare Part D PDP plans in MS cover SUCRAID 8500UNITS/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in MS cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFACETAMIDE 10% EYE OINT ![Compare how all Medicare Part D PDP plans in MS cover SULFACETAMIDE 10% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFACETAMIDE SODIUM 10% DROPS ![Compare how all Medicare Part D PDP plans in MS cover SULFACETAMIDE SODIUM 10% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in MS cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in MS cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in MS cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in MS cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in MS cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in MS cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFASALAZINE DR 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MS cover SULFASALAZINE DR 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULFAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SULFAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in MS cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:4 /30Days |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in MS cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:4 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in MS cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:9 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in MS cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:9 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in MS cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generics |
$10.00 | N/A | Q:9 /30Days |
SUSTIVA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUSTIVA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MS cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Speciality (Brand or Generic) |
25% | N/A | P |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MS cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MS cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MS cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MS cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 137MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 137MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in MS cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Preferred Brand |
$25.00 | N/A | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MS cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - NonPreferred Brand, NonPreferred Generic |
$50.00 | N/A | None |