2009 Medicare Part D Plan Formulary Information |
BlueRx Plus (S5593-002-0)
Benefit Details
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The BlueRx Plus (S5593-002-0) Formulary Drugs Starting with the Letter C in CMS PDP Region 6 which includes: PA WV
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CABERGOLINE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CADUET 10MG/10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 10MG/10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 10MG/20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 10MG/20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 10MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 10MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 10MG/80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 10MG/80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 2.5MG/10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 2.5MG/10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 2.5MG/20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 2.5MG/20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 2.5MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 2.5MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 5MG/10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 5MG/10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 5MG/20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 5MG/20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CADUET 5MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 5MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CADUET 5MG/80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CADUET 5MG/80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAFERGOT 1-100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAFERGOT 1-100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CALAN 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CALAN 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CALAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CALAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALAN SR 120MG CAPLET SA ![Compare how all Medicare Part D PDP plans in PA cover CALAN SR 120MG CAPLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALAN SR 180MG CAPLET SA ![Compare how all Medicare Part D PDP plans in PA cover CALAN SR 180MG CAPLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALAN SR TABLET 240MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CALAN SR TABLET 240MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALCIJEX 1 MCG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover CALCIJEX 1 MCG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALCITRIOL 0.25MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 0.25MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CALCITRIOL 2 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 2 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAMILA 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAMILA 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAMPATH 30MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CAMPATH 30MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAMPRAL 333MG DOSE PAK ![Compare how all Medicare Part D PDP plans in PA cover CAMPRAL 333MG DOSE PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CAMPTOSAR 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CAMPTOSAR 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in PA cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CANTIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CANTIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPASTAT SULFATE 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CAPASTAT SULFATE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPEX SHA 0.01% ![Compare how all Medicare Part D PDP plans in PA cover CAPEX SHA 0.01%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPITAL W/CODEINE ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CAPITAL W/CODEINE ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CAPOTEN 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPOTEN 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPOTEN 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPOTEN 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPOTEN 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPOTEN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPOZIDE 25MG-15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPOZIDE 25MG-15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPOZIDE 25MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPOZIDE 25MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL/HCTZ 25/15 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL/HCTZ 25/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL/HCTZ 25/25 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL/HCTZ 25/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL/HCTZ 50/15 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL/HCTZ 50/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CAPTOPRIL/HCTZ 50/25 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL/HCTZ 50/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARAC CRE 0.5% ![Compare how all Medicare Part D PDP plans in PA cover CARAC CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARAFATE SUCRALFATE 1G TABLET ORAL ![Compare how all Medicare Part D PDP plans in PA cover CARAFATE SUCRALFATE 1G TABLET ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in PA cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CARBAMAZEPINE 100MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE 100MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBATROL 100MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 100MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARBATROL 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARBATROL 300MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 300MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBOPLATIN AQUEOUS SOLUTION INJECTION 150MG 15ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARBOPLATIN AQUEOUS SOLUTION INJECTION 150MG 15ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBOPLATIN AQUEOUS SOLUTION INJECTION 50MG 5ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARBOPLATIN AQUEOUS SOLUTION INJECTION 50MG 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBOPLATIN INJECTION 10MG 1 X 45ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARBOPLATIN INJECTION 10MG 1 X 45ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARBOPLATIN INJECTION AQUEOUS SOLUTION 10MG 1 X 60ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARBOPLATIN INJECTION AQUEOUS SOLUTION 10MG 1 X 60ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARDENE 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CARDENE 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDENE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CARDENE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDENE IV 2.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover CARDENE IV 2.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDENE SR (NICARDIPINE HCL) 30MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARDENE SR (NICARDIPINE HCL) 30MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDENE SR (NICARDIPINE HCL) 45MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARDENE SR (NICARDIPINE HCL) 45MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDENE SR (NICARDIPINE HCL) 60MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARDENE SR (NICARDIPINE HCL) 60MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARDIZEM 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM 60MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM CAPSULES 180MG (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM CAPSULES 180MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM CD 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM CD 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM CD 240MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM CD 240MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM CD 300MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM CD 300MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM CD 360MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM CD 360MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM LA 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM LA 180MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 180MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARDIZEM LA 240MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 240MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM LA 300MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 300MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM LA 360MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 360MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDIZEM LA 420MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDIZEM LA 420MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA 8MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA XL 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA XL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARDURA XL 8MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARDURA XL 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARIMUNE NF 12GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARIMUNE NF 12GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARIMUNE NF 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARIMUNE NF 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | P |
CARIMUNE NF 3GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARIMUNE NF 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | P |
CARIMUNE NF 6GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARIMUNE NF 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | P |
CARISOPRODOL COMPOUND (CARISOPRODOL/ASPIRIN) 200-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARISOPRODOL COMPOUND (CARISOPRODOL/ASPIRIN) 200-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARISOPRODOL CPD/CODEINE TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARISOPRODOL CPD/CODEINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARISOPRODOL TABLET USP 350MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARISOPRODOL TABLET USP 350MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARMOL HC 1%-10% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CARMOL HC 1%-10% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARNITOR 100MG/ML ORAL TUBEX ![Compare how all Medicare Part D PDP plans in PA cover CARNITOR 100MG/ML ORAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARNITOR 1GM/5ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARNITOR 1GM/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARNITOR 330MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARNITOR 330MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
carteolol 2.5MG oral TABLET ![Compare how all Medicare Part D PDP plans in PA cover carteolol 2.5MG oral TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
carteolol 5MG oral TABLET ![Compare how all Medicare Part D PDP plans in PA cover carteolol 5MG oral TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARTIA XT 300MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 300MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARVEDILOL 12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARVEDILOL 25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARVEDILOL 3.125MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 3.125MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CARVEDILOL 6.25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 6.25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CASODEX 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CASODEX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CATAFLAM 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CATAFLAM 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CATAPRES 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CATAPRES 0.2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES 0.2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CATAPRES 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CATAPRES-TTS DIS 0.3/24HR ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES-TTS DIS 0.3/24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CATAPRES-TTS-1 PATCH 2.52.5MG/UNT 1 X 4 CRTN ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES-TTS-1 PATCH 2.52.5MG/UNT 1 X 4 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CATAPRES-TTS-2 PATCH 52.5MG/UNT 1 X 4 CRTN ![Compare how all Medicare Part D PDP plans in PA cover CATAPRES-TTS-2 PATCH 52.5MG/UNT 1 X 4 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEDAX 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEDAX 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEDAX 90MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEDAX 90MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEENU 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEENU 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEENU 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEENU PAK DOSEPACK 1 KIT ![Compare how all Medicare Part D PDP plans in PA cover CEENU PAK DOSEPACK 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFACLOR 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFACLOR 375MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR 375MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFACLOR CAPSULES USP 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR CAPSULES USP 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFACLOR CAPSULES USP 500MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR CAPSULES USP 500MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFACLOR ER 500MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR ER 500MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFADROXIL 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFAZOLIN 1GM ADD-VAN VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 1GM ADD-VAN VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFAZOLIN 1GM/D5W BAG ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 1GM/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFAZOLIN 20GM BULK VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 20GM BULK VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFAZOLIN 500MG/D5W BAG ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 500MG/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFAZOLIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFAZOLIN FOR INJECTION 10GM 10 X 10 VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN FOR INJECTION 10GM 10 X 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFAZOLIN FOR INJECTION 1MG 25 VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN FOR INJECTION 1MG 25 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFIZOX 1GM IN D5W 50ML ![Compare how all Medicare Part D PDP plans in PA cover CEFIZOX 1GM IN D5W 50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFIZOX 2GM IN D5W 50ML ![Compare how all Medicare Part D PDP plans in PA cover CEFIZOX 2GM IN D5W 50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFOTAXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOTAXIME FOR INJECTION 2GM 25 VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 2GM 25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOTAXIME FOR INJECTION 500MG 10 VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 500MG 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOTAXIME SODIUM 20GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME SODIUM 20GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFOXITIN FOR INJECTION 10GM 10 X 100ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN FOR INJECTION 10GM 10 X 100ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOXITIN FOR INJECTION 1GM 25 X 20ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN FOR INJECTION 1GM 25 X 20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFOXITIN FOR INJECTION 2GM 20ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN FOR INJECTION 2GM 20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPODOXIME PROXETIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME PROXETIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPROZIL 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPROZIL 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTIN 125MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEFTIN 125MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFTIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFTIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFTIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEFTIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFTIN 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFTIN 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTRIAXONE 10GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE 1GM PIGGYBACK ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 1GM PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE 2GM PIGGYBACK ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 2GM PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE FOR INJECTION 1GM 10 VIALSU ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 1GM 10 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE FOR INJECTION 2GM 10 VIALSU ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 2GM 10 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 1 GM/50ML ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 1 GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 2 GM/50ML ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 2 GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CEFUROXIME 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME AXETIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME AXETIL 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME FOR INJECTION 7.5GM 10 X 7.5 VIALPHR ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION 7.5GM 10 X 7.5 VIALPHR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFZIL 125MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFZIL 125MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFZIL 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFZIL 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFZIL 250MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFZIL 250MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEFZIL 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFZIL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CELEBREX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CELEBREX 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CELEBREX 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CELEBREX 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CELESTONE 0.6MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CELESTONE 0.6MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CELEXA 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CELEXA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CELEXA 10MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CELEXA 10MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CELEXA 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CELEXA 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CELEXA 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CELEXA 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CELLCEPT 200MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT 200MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CELLCEPT 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CELLCEPT CAPSULES 250MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT CAPSULES 250MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CELLCEPT IV INJ 500MG ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT IV INJ 500MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CELONTIN 300MG KAPSEAL ![Compare how all Medicare Part D PDP plans in PA cover CELONTIN 300MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CENESTIN 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CENESTIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CENESTIN 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CENESTIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CENESTIN 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEPHALEXIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEPHALEXIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEPHALEXIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEPHALEXIN CAPSULES 500MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN CAPSULES 500MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CEREBYX 50MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEREBYX 50MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEREDASE 80UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEREDASE 80UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CEREZYME INJ 200UNIT ![Compare how all Medicare Part D PDP plans in PA cover CEREZYME INJ 200UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
CEREZYME INJ 400UNIT ![Compare how all Medicare Part D PDP plans in PA cover CEREZYME INJ 400UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
CERUBIDINE 20MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CERUBIDINE 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CESAMET 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CESAMET 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CESIA 7 DAYS X 3 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CESIA 7 DAYS X 3 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHANTIX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHANTIX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHANTIX 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHANTIX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CHANTIX STARTING MONTH PAK ![Compare how all Medicare Part D PDP plans in PA cover CHANTIX STARTING MONTH PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CHEMET 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHEMET 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CHLORAMPHEN NA SUCC 1GM VL ![Compare how all Medicare Part D PDP plans in PA cover CHLORAMPHEN NA SUCC 1GM VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in PA cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in PA cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLOROQUINE PH 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PH 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLOROTHIAZIDE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROTHIAZIDE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLOROTHIAZIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROTHIAZIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROMAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROMAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROMAZINE 25MG/ML AMP ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 25MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROMAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROMAZINE HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROPAMIDE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROPAMIDE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORPROPAMIDE 250MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROPAMIDE 250MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORTHALIDONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORTHALIDONE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHLORZOXAZONE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORZOXAZONE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORZOXAZONE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORZOXAZONE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 210GM CAN ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 210GM CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 60 X 5 SINGLE DOSE CRTN ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 60 X 5 SINGLE DOSE CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 60 X 9GM SINGLE DOSE CRTN ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 60 X 9GM SINGLE DOSE CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 378GM CAN ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 378GM CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CHORIONIC GONAD 10000U VIAL ![Compare how all Medicare Part D PDP plans in PA cover CHORIONIC GONAD 10000U VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CICLOPIROX 0.77% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 0.77% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CICLOPIROX 0.77% TOPICAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 0.77% TOPICAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CILOSTAZOL 50MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL 50MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CILOXAN SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CILOXAN SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CIMETIDINE 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMETIDINE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMETIDINE HCL 300MG/5ML SOL ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE HCL 300MG/5ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMETIDINE TABLET USP 300MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE TABLET USP 300MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMETIDINE TABLET USP 400MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE TABLET USP 400MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMETIDINE TABLET USP 800MG (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE TABLET USP 800MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIMZIA KIT ![Compare how all Medicare Part D PDP plans in PA cover CIMZIA KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | P |
CIPRO (10%) SUS 500MG/5 ![Compare how all Medicare Part D PDP plans in PA cover CIPRO (10%) SUS 500MG/5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRO (5%) SUS 250MG/5 ![Compare how all Medicare Part D PDP plans in PA cover CIPRO (5%) SUS 250MG/5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRO 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIPRO 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPRO 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIPRO 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CIPRO 750MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIPRO 750MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CIPRO HC OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CIPRO HC OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CIPRO IV 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CIPRO IV 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRO IV 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CIPRO IV 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRO IV INFUSION 200MG 100ML BAG ![Compare how all Medicare Part D PDP plans in PA cover CIPRO IV INFUSION 200MG 100ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRO IV INJECTION 400MG 200ML BAG ![Compare how all Medicare Part D PDP plans in PA cover CIPRO IV INJECTION 400MG 200ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CIPROFLOXACIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN 750MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 750MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN ER 1000MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN ER 1000MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN ER 500MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN ER 500MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN HCL 0.3% DROPS ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CIPROFLOXACIN HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CISPLATIN INJECTION 1MG ![Compare how all Medicare Part D PDP plans in PA cover CISPLATIN INJECTION 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CITALOPRAM HBR 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CITALOPRAM HBR 40MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 40MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CITOLOPRAM HBR 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CITOLOPRAM HBR 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLADRIBINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLADRIBINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLAFORAN 10GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN 1GM/50ML GALAXY ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 1GM/50ML GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN 2GM ADD-VANTAGE VL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 2GM ADD-VANTAGE VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN 2GM/50ML GALAXY ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 2GM/50ML GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLAFORAN INJECTION STERILE 2GM 10 X 2GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLAFORAN INJECTION STERILE 2GM 10 X 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARAVIS 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARAVIS 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARAVIS 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARAVIS 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARINEX 0.5MG/ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX 0.5MG/ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARINEX 2.5MG REDITABS ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX 2.5MG REDITABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARINEX 5MG REDITABS ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX 5MG REDITABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARINEX 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARINEX-D 12 HOUR TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX-D 12 HOUR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARINEX-D 24 HOUR TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARINEX-D 24 HOUR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLARITHROMYCIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARITHROMYCIN 250MG/5ML. SUS. 100ML ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 250MG/5ML. SUS. 100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARITHROMYCIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLARITHROMYCIN ER 500MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN ER 500MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARITHROMYCIN FOR ORAL SUSPENSION 125/5ML 125MG BOT ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN FOR ORAL SUSPENSION 125/5ML 125MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLEMASTINE FUM 2.68MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLEMASTINE FUM 2.68MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLEMASTINE FUMARATE 0.67MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CLEMASTINE FUMARATE 0.67MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLEOCIN 100MG VAGINAL OVULE ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 100MG VAGINAL OVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN 2% VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 2% VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN 300MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 300MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN 600MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 600MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN 900MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 900MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN HCL 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN HCL 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLEOCIN PED SOL 75MG/5ML ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN PED SOL 75MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLEOCIN PHOS 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN PHOS 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN PHOS 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN PHOS 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN T 1% GEL ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN T 1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN T 1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN T 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN T 1% PLEDGETS ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN T 1% PLEDGETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLEOCIN T 1% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN T 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLIMARA 0.025MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.025MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLIMARA 0.0375MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.0375MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLIMARA 0.05MG/24H PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.05MG/24H PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLIMARA 0.06/MG DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.06/MG DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLIMARA 0.075MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.075MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLIMARA 0.1MG/24H PATCH ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA 0.1MG/24H PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG ![Compare how all Medicare Part D PDP plans in PA cover CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLINDAGEL 1% GEL ![Compare how all Medicare Part D PDP plans in PA cover CLINDAGEL 1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLINDAMYCIN 150MG/ML ADDVAN ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN 150MG/ML ADDVAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN HCL 300MG CAPS ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 300MG CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN INJECTION 150MG/60ML VIAL PHAR CRTN ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN INJECTION 150MG/60ML VIAL PHAR CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN PHOSP 1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSP 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN PHOSPHATE 2% CREAM WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSPHATE 2% CREAM WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLINDESSE 2% VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLINDESSE 2% VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLINIMIX 2.75%/5% INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 2.75%/5% INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 4.25/10 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 4.25/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 4.25/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 4.25/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 5/15 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 5/15 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX E 2.75/10 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 2.75/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 5/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 5/35 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5/35 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINIMIX E 5%/15% INJECTION 2000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5%/15% INJECTION 2000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CLINISOL 15% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINISOL 15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CLINORIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLINORIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLOBETASOL 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBETASOL 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOBETASOL 0.05% GEL ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOBETASOL 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOBEX 0.05% SHAMPOO ![Compare how all Medicare Part D PDP plans in PA cover CLOBEX 0.05% SHAMPOO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLOBEX 0.05% SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in PA cover CLOBEX 0.05% SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLOBEX 0.05% TOPICAL LOTION ![Compare how all Medicare Part D PDP plans in PA cover CLOBEX 0.05% TOPICAL LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLODERM 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLODERM 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLORPRES 0.1/15 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLORPRES 0.1/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLORPRES 0.2/15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLORPRES 0.2/15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLORPRES 0.3/15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLORPRES 0.3/15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CREAM USP .5MG-10GM 45GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CREAM USP .5MG-10GM 45GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOZAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOZAPINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CLOZARIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLOZARIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CLOZARIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLOZARIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CO-GESIC 5/500 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CO-GESIC 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COGENTIN 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover COGENTIN 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COGNEX 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COGNEX 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COGNEX 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COGNEX 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COGNEX 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COGNEX 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COGNEX 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COGNEX 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COLAZAL 750MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COLAZAL 750MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COLCHICINE TABLET USP 0.6MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover COLCHICINE TABLET USP 0.6MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
COLESTID 1GM TABLET ![Compare how all Medicare Part D PDP plans in PA cover COLESTID 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLESTID FLAVORED GRANULES ![Compare how all Medicare Part D PDP plans in PA cover COLESTID FLAVORED GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLESTID FLAVORED GRANULES ![Compare how all Medicare Part D PDP plans in PA cover COLESTID FLAVORED GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLESTID GRANULES ![Compare how all Medicare Part D PDP plans in PA cover COLESTID GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLESTID GRANULES 5GM NS ![Compare how all Medicare Part D PDP plans in PA cover COLESTID GRANULES 5GM NS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in PA cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLESTIPOL HCL 5G GRANULES ![Compare how all Medicare Part D PDP plans in PA cover COLESTIPOL HCL 5G GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
COLISTIMETHATE 150MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover COLISTIMETHATE 150MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COLOCORT 100MG ENEMA ![Compare how all Medicare Part D PDP plans in PA cover COLOCORT 100MG ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COLY-MYCIN M 150MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover COLY-MYCIN M 150MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
COLY-MYCIN S EAR DROPS ![Compare how all Medicare Part D PDP plans in PA cover COLY-MYCIN S EAR DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COLYTE SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover COLYTE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COLYTE WITH FLAVOR PACKETS ![Compare how all Medicare Part D PDP plans in PA cover COLYTE WITH FLAVOR PACKETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COMBIGAN 0.2%-0.5% DROPS ![Compare how all Medicare Part D PDP plans in PA cover COMBIGAN 0.2%-0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COMBIPATCH 0.05/0.14MG PTCH ![Compare how all Medicare Part D PDP plans in PA cover COMBIPATCH 0.05/0.14MG PTCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COMBIPATCH 0.05/0.25MG PTCH ![Compare how all Medicare Part D PDP plans in PA cover COMBIPATCH 0.05/0.25MG PTCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMBIVENT INHALER ![Compare how all Medicare Part D PDP plans in PA cover COMBIVENT INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COMBIVIR TABLET ![Compare how all Medicare Part D PDP plans in PA cover COMBIVIR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COMBUNOX 5/400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COMBUNOX 5/400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in PA cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
COMTAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COMTAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PA cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CONCERTA 18MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CONCERTA 18MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CONCERTA 27MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CONCERTA 27MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CONCERTA 36MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CONCERTA 36MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CONCERTA 54MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CONCERTA 54MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CONDYLOX 0.5% GEL ![Compare how all Medicare Part D PDP plans in PA cover CONDYLOX 0.5% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CONDYLOX 0.5% TOPICAL TUBEX ![Compare how all Medicare Part D PDP plans in PA cover CONDYLOX 0.5% TOPICAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CONSTULOSE 10GM/15ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CONSTULOSE 10GM/15ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
COPAXONE 20MG INJECTION KIT ![Compare how all Medicare Part D PDP plans in PA cover COPAXONE 20MG INJECTION KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
COPEGUS 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COPEGUS 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
CORDARONE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORDARONE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORDRAN 0.05% LOTION ![Compare how all Medicare Part D PDP plans in PA cover CORDRAN 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORDRAN 24X3 TAP 4MCG/CM ![Compare how all Medicare Part D PDP plans in PA cover CORDRAN 24X3 TAP 4MCG/CM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORDRAN SP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CORDRAN SP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COREG 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COREG 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG 3.125MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COREG 3.125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COREG 6.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COREG 6.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in PA cover COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in PA cover COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in PA cover COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in PA cover COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORGARD (NADOLOL) 80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORGARD (NADOLOL) 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORGARD 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CORGARD 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORGARD 40MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CORGARD 40MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORMAX 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CORMAX 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CORMAX 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CORMAX 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CORMAX 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CORMAX 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CORTEF 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORTEF 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORTEF 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORTEF 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORTEF 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORTEF 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORTIFOAM 10% FOAM ![Compare how all Medicare Part D PDP plans in PA cover CORTIFOAM 10% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORTISONE ACETATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CORTISONE ACETATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CORTISPORIN CRE 0.5% ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORTISPORIN EAR SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN EAR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORTISPORIN EAR SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN EAR SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORTISPORIN EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORTISPORIN OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CORTISPORIN SUS -TC OTIC ![Compare how all Medicare Part D PDP plans in PA cover CORTISPORIN SUS -TC OTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CORTOMYCIN EAR SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CORTOMYCIN EAR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CORTOMYCIN EAR SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CORTOMYCIN EAR SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CORZIDE 40-5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORZIDE 40-5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CORZIDE 80-5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORZIDE 80-5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COSMEGEN 0.5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover COSMEGEN 0.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COSOPT PLUS EYE DROPS 22.3 MG/ML 6.8 MG/M ![Compare how all Medicare Part D PDP plans in PA cover COSOPT PLUS EYE DROPS 22.3 MG/ML 6.8 MG/M.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COUMADIN 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COUMADIN 6MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COUMADIN 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COUMADIN 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
COVERA-HS 180MG SA TABLET ![Compare how all Medicare Part D PDP plans in PA cover COVERA-HS 180MG SA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COVERA-HS 240MG SA TABLET ![Compare how all Medicare Part D PDP plans in PA cover COVERA-HS 240MG SA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COZAAR 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COZAAR 25MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 25MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
COZAAR 50MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 50MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CREON 10 CAPSULE EC ![Compare how all Medicare Part D PDP plans in PA cover CREON 10 CAPSULE EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CREON 20 CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CREON 20 CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CREON 5 CAPSULE EC ![Compare how all Medicare Part D PDP plans in PA cover CREON 5 CAPSULE EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CRESTOR 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CRESTOR 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CRESTOR 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CRESTOR 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CRINONE GEL 8% VAG ![Compare how all Medicare Part D PDP plans in PA cover CRINONE GEL 8% VAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CRIXIVAN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CRIXIVAN 333MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 333MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CRIXIVAN 400MG CAPSULE (120 CT) ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 400MG CAPSULE (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CROLOM 4% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover CROLOM 4% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CRYSELLE-28 TABLET 28 TABLET S ![Compare how all Medicare Part D PDP plans in PA cover CRYSELLE-28 TABLET 28 TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
CUPRIMINE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CUPRIMINE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CUPRIMINE CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CUPRIMINE CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CUTIVATE CREAM 0.05% ![Compare how all Medicare Part D PDP plans in PA cover CUTIVATE CREAM 0.05%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CUTIVATE LOTION 0.05% ![Compare how all Medicare Part D PDP plans in PA cover CUTIVATE LOTION 0.05%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CUTIVATE OINTMENT 0.005% 60GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover CUTIVATE OINTMENT 0.005% 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYCLESSA 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYCLESSA 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE HCL 5MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYCLOPHOSPHAMIDE 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYCLOPHOSPHAMIDE 2GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYCLOPHOSPHAMIDE 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYCLOSPORINE 100MG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 100MG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYCLOSPORINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | P |
CYCLOSPORINE 50MG/ML AMP ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 50MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | P |
CYKLOKAPRON 100MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover CYKLOKAPRON 100MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYMBALTA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CYMBALTA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | P |
CYPROHEPTADINE 2MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE 2MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYPROHEPTADINE 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in PA cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYTARABINE 100MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYTARABINE 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYTARABINE 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYTARABINE 2GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYTARABINE 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$5.00 | $12.50 | None |
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOMEL 25MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYTOMEL 50MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYTOMEL 5MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $87.50 | None |
CYTOTEC TABLET 100MCG (120 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYTOTEC TABLET 100MCG (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOTEC TABLET 200MCG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYTOTEC TABLET 200MCG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOVENE 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTOVENE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYTOXAN 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTOXAN 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOXAN 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOXAN 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOXAN 2GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTOXAN 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOXAN 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CYTOXAN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |
CYTOXAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOXAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$65.00 | $162.50 | None |