2009 Medicare Part D Plan Formulary Information |
MedicareBlue Rx Option 3 (S5743-004-0)
Benefit Details
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The MedicareBlue Rx Option 3 (S5743-004-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SANCTURA 20MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SANCTURA 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | Q:60 /30Days |
SANCTURA XR 60MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in MT cover SANCTURA XR 60MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | Q:30 /30Days |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in MT cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in MT cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in MT cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in MT cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in MT cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:60 /30Days |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:90 /30Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:90 /30Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:90 /30Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:60 /30Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:60 /30Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:90 /30Days |
SEROQUEL XR 200MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL XR 200MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:30 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL XR 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SEROQUEL XR 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:60 /30Days |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MT cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SERTRALINE HCL 20MG/ML CONCENTRATE ORAL ![Compare how all Medicare Part D PDP plans in MT cover SERTRALINE HCL 20MG/ML CONCENTRATE ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SERTRALINE HCL 20MG/ML CONCENTRATE ORAL ![Compare how all Medicare Part D PDP plans in MT cover SERTRALINE HCL 20MG/ML CONCENTRATE ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SERTRALINE HCL 25MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MT cover SERTRALINE HCL 25MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MT cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in MT cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SIMULECT 10MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SIMULECT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | P |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | P |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MT cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:45 /30Days |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in MT cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:45 /30Days |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MT cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:45 /30Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MT cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:30 /30Days |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | S |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in MT cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MT cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MT cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SODIUM CHLORIDE 0.9% IRRIG ![Compare how all Medicare Part D PDP plans in MT cover SODIUM CHLORIDE 0.9% IRRIG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in MT cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in MT cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM POLYSTYRENE SULFONATE 15G/60ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in MT cover SODIUM POLYSTYRENE SULFONATE 15G/60ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SODIUM POLYSTYRENE SULFONATE 30G/120ML ENEMA ![Compare how all Medicare Part D PDP plans in MT cover SODIUM POLYSTYRENE SULFONATE 30G/120ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SODIUM POLYSTYRENE SULFONATE 50G/200ML ENEMA ![Compare how all Medicare Part D PDP plans in MT cover SODIUM POLYSTYRENE SULFONATE 50G/200ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in MT cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in MT cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOLTAMOX 10MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover SOLTAMOX 10MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SORIATANE 25MG ![Compare how all Medicare Part D PDP plans in MT cover SORIATANE 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SORIATANE CK 25MG KIT ![Compare how all Medicare Part D PDP plans in MT cover SORIATANE CK 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE 120MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SORINE 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SORINE 160MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SORINE 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SORINE 240MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SORINE 240MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SORINE 80MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SORINE 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 120MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 120MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL 80MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL 80MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in MT cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in MT cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:30 /30Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in MT cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in MT cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SPS 15GM/60ML SUSPENSION ![Compare how all Medicare Part D PDP plans in MT cover SPS 15GM/60ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SPS 30GM/120ML ENEMA ![Compare how all Medicare Part D PDP plans in MT cover SPS 30GM/120ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in MT cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in MT cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SSD AF 1% CREAM ![Compare how all Medicare Part D PDP plans in MT cover SSD AF 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in MT cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STARLIX 120MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover STARLIX 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STARLIX 60MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover STARLIX 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in MT cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in MT cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in MT cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in MT cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STERILE GAUZE PADS 2X 2 ![Compare how all Medicare Part D PDP plans in MT cover STERILE GAUZE PADS 2X 2.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in MT cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in MT cover STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
STIMATE 1.5MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MT cover STIMATE 1.5MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in MT cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
STROMECTOL 6MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover STROMECTOL 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUBUTEX 2MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUBUTEX 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUBUTEX 8MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUBUTEX 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUCRAID 8500UNITS/ML SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover SUCRAID 8500UNITS/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULAR 17MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SULAR 17MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SULAR 25.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SULAR 25.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SULAR 34MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SULAR 34MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SULAR 8.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MT cover SULAR 8.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SULF-10 OPHTHALMIC SOLUTION 10% ![Compare how all Medicare Part D PDP plans in MT cover SULF-10 OPHTHALMIC SOLUTION 10%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFACETAMIDE SODIUM 10% DROPS ![Compare how all Medicare Part D PDP plans in MT cover SULFACETAMIDE SODIUM 10% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in MT cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in MT cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in MT cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in MT cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAMETHOXAZOLE/TMP DS TAB ![Compare how all Medicare Part D PDP plans in MT cover SULFAMETHOXAZOLE/TMP DS TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFASALAZINE DR 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover SULFASALAZINE DR 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFATRIM PEDIATRIC SUSP ![Compare how all Medicare Part D PDP plans in MT cover SULFATRIM PEDIATRIC SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SULFAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in MT cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:6 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in MT cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:18 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in MT cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:18 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in MT cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Level 1: Covered Generic |
$3.00 | $6.00 | Q:18 /30Days |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in MT cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |
SUSTIVA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUSTIVA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in MT cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:10 /30Days |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in MT cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | Q:10 /30Days |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MT cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MT cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Level 2: Covered Preferred Brand |
$37.00 | $74.00 | None |
SYNAGIS 100MG/1ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover SYNAGIS 100MG/1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MT cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Covered Specialty |
33% | 33% | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Level 3: Covered Brand |
50% | 50% | None |