2009 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Essentials (S5810-039-0)
Benefit Details
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The Aetna Medicare Rx Essentials (S5810-039-0) Formulary Drugs Starting with the Letter O in CMS PDP Region 5 which includes: DC DE MD
|
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCELLA TABLET ![Compare how all Medicare Part D PDP plans in MD cover OCELLA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG ![Compare how all Medicare Part D PDP plans in MD cover OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG ![Compare how all Medicare Part D PDP plans in MD cover OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG ![Compare how all Medicare Part D PDP plans in MD cover OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG ![Compare how all Medicare Part D PDP plans in MD cover OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD ![Compare how all Medicare Part D PDP plans in MD cover OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in MD cover OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in MD cover OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD ![Compare how all Medicare Part D PDP plans in MD cover OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP ![Compare how all Medicare Part D PDP plans in MD cover OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OCUFEN 0.03% EYE DROPS ![Compare how all Medicare Part D PDP plans in MD cover OCUFEN 0.03% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OCUFLOX 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in MD cover OCUFLOX 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OCUSULF-10 EYE DROPS ![Compare how all Medicare Part D PDP plans in MD cover OCUSULF-10 EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in MD cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OFLOXACIN 0.3% DROPS ![Compare how all Medicare Part D PDP plans in MD cover OFLOXACIN 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OFLOXACIN 200MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in MD cover OFLOXACIN 200MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OFLOXACIN 300MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in MD cover OFLOXACIN 300MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OFLOXACIN 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OFLOXACIN 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in MD cover OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OGEN 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OGEN 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | P |
OGEN 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OGEN 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OGEN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OGEN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | P |
OGESTREL TABLET 0.05MG/0.5MG ![Compare how all Medicare Part D PDP plans in MD cover OGESTREL TABLET 0.05MG/0.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OLOPATADINE HCL 0.6% SPRAY SOLUTION NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MD cover OLOPATADINE HCL 0.6% SPRAY SOLUTION NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OLUX 0.05% FOAM ![Compare how all Medicare Part D PDP plans in MD cover OLUX 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OLUX-E 0.05% FOAM ![Compare how all Medicare Part D PDP plans in MD cover OLUX-E 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT) ![Compare how all Medicare Part D PDP plans in MD cover OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:1 /1Days |
OMEPRAZOLE 20MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MD cover OMEPRAZOLE 20MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:2 /1Days |
OMEPRAZOLE DR CAPSULE ![Compare how all Medicare Part D PDP plans in MD cover OMEPRAZOLE DR CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:1 /1Days |
OMNARIS 50MCG SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in MD cover OMNARIS 50MCG SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OMNICEF 125MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in MD cover OMNICEF 125MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OMNICEF 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in MD cover OMNICEF 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMNICEF 300MG OMNI-PAC CAP ![Compare how all Medicare Part D PDP plans in MD cover OMNICEF 300MG OMNI-PAC CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OMNICEF SUS 250/5ML ![Compare how all Medicare Part D PDP plans in MD cover OMNICEF SUS 250/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM ![Compare how all Medicare Part D PDP plans in MD cover OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG ![Compare how all Medicare Part D PDP plans in MD cover OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in MD cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
ONCASPAR 750UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in MD cover ONCASPAR 750UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
ONDANSETRON HCL 24MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON HCL 24MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:5 /30Days |
ONDANSETRON HCL 4MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON HCL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:6 /1Days |
ONDANSETRON HCL 4MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON HCL 4MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:30 /1Days |
ONDANSETRON HCL 8MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON HCL 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:3 /1Days |
ONDANSETRON INJECTION 2MG 5X2ML VIAL ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON INJECTION 2MG 5X2ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ONDANSETRON ODT 4MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON ODT 4MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:6 /1Days |
ONDANSETRON ODT 8MG (10 CT) ![Compare how all Medicare Part D PDP plans in MD cover ONDANSETRON ODT 8MG (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P Q:3 /1Days |
ONTAK INJECTION 300MCG/2ML VIALSU ![Compare how all Medicare Part D PDP plans in MD cover ONTAK INJECTION 300MCG/2ML VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
ONXOL PACLITAXEL INJECTION 6 MG/ML ![Compare how all Medicare Part D PDP plans in MD cover ONXOL PACLITAXEL INJECTION 6 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OPANA 10MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | S Q:6 /1Days |
OPANA 5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | S Q:6 /1Days |
OPANA ER 10MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPANA ER 15MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 15MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPANA ER 20MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPANA ER 30MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 30MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPANA ER 40MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPANA ER 5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPANA ER 7.5MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OPANA ER 7.5MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
OPTIPRANOLOL 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in MD cover OPTIPRANOLOL 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OPTIVAR 0.05% DROPS ![Compare how all Medicare Part D PDP plans in MD cover OPTIVAR 0.05% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |
ORACEA 40MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in MD cover ORACEA 40MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | P Q:1 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MD cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P Q:4 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORAMORPH SR 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover ORAMORPH SR 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAMORPH SR 15MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover ORAMORPH SR 15MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAMORPH SR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover ORAMORPH SR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAMORPH SR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover ORAMORPH SR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAP 1MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORAP 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAP 2MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORAP 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAPRED 15MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in MD cover ORAPRED 15MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAPRED ODT 10MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in MD cover ORAPRED ODT 10MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAPRED ODT 15MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in MD cover ORAPRED ODT 15MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORAPRED ODT 30MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in MD cover ORAPRED ODT 30MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORENCIA 250MG VIAL ![Compare how all Medicare Part D PDP plans in MD cover ORENCIA 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORFADIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MD cover ORFADIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
ORFADIN 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in MD cover ORFADIN 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
ORFADIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MD cover ORFADIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
ORPHENADRINE CITRATE ASPIRIN AND CAFFEINE TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORPHENADRINE CITRATE ASPIRIN AND CAFFEINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
ORPHENADRINE CITRATE ER TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover ORPHENADRINE CITRATE ER TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
ORPHENADRINE CITRATE INJECTION 3030MG/ML 10ML VIAL ![Compare how all Medicare Part D PDP plans in MD cover ORPHENADRINE CITRATE INJECTION 3030MG/ML 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
ORPHENADRINE COMP FORTE TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORPHENADRINE COMP FORTE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
ORPHENADRINE COMPOUND 25-385-30 TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORPHENADRINE COMPOUND 25-385-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
ORTHO EVRA DIS WEEK .75MG / 6MG ![Compare how all Medicare Part D PDP plans in MD cover ORTHO EVRA DIS WEEK .75MG / 6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHO MICRON TABLET DIALPAK ![Compare how all Medicare Part D PDP plans in MD cover ORTHO MICRON TABLET DIALPAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHO TRI-CYCLEN LO TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO TRI-CYCLEN LO TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORTHO-CEPT 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-CEPT 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHO-CYCLEN TABLET 0.25/35 ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-CYCLEN TABLET 0.25/35.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHO-EST 0.625 TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-EST 0.625 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
ORTHO-EST 1.25 TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-EST 1.25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
ORTHO-NOVUM 1/50-28 TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-NOVUM 1/50-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHO-NOVUM 7/7/7-28 TABLET ![Compare how all Medicare Part D PDP plans in MD cover ORTHO-NOVUM 7/7/7-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
ORTHOCLONE OKT-3 5MG/5ML ![Compare how all Medicare Part D PDP plans in MD cover ORTHOCLONE OKT-3 5MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OSMOPREP TABLET 1.5GM ![Compare how all Medicare Part D PDP plans in MD cover OSMOPREP TABLET 1.5GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OTICIN HC 3.5-10K-1 SUSPENSION DROPS ![Compare how all Medicare Part D PDP plans in MD cover OTICIN HC 3.5-10K-1 SUSPENSION DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OVCON-35 28 TABLET ![Compare how all Medicare Part D PDP plans in MD cover OVCON-35 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OVCON-50 28 TABLET ![Compare how all Medicare Part D PDP plans in MD cover OVCON-50 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OVIDE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in MD cover OVIDE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN 1GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXACILLIN FOR INJECTION 1 GM ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN FOR INJECTION 1 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXACILLIN FOR INJECTION 2 GM/VIAL ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN FOR INJECTION 2 GM/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXACILLIN INJECTION ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OXACILLIN SODIUM FOR INJECTION 1 GM/VIAL ![Compare how all Medicare Part D PDP plans in MD cover OXACILLIN SODIUM FOR INJECTION 1 GM/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXANDRIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXANDRIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OXANDRIN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXANDRIN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | P |
OXANDROLONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXANDROLONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | P |
OXANDROLONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXANDROLONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXAPROZIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXAPROZIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXCARBAZEPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXCARBAZEPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXCARBAZEPINE 300MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in MD cover OXCARBAZEPINE 300MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXCARBAZEPINE 600MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in MD cover OXCARBAZEPINE 600MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXISTAT 1% CREAM 30GM TUBE ![Compare how all Medicare Part D PDP plans in MD cover OXISTAT 1% CREAM 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXISTAT 1% LOTION ![Compare how all Medicare Part D PDP plans in MD cover OXISTAT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXSORALEN 1% LOTION ![Compare how all Medicare Part D PDP plans in MD cover OXSORALEN 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$72.00 | $144.00 | None |
OXSORALEN-ULTRA 10MG CAP ![Compare how all Medicare Part D PDP plans in MD cover OXSORALEN-ULTRA 10MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
25% | 25% | None |
OXYBUTYNIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYBUTYNIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYBUTYNIN CHLORIDE SYRUP USP 5MG/5ML 5 ML UNIT DOSE CUP ![Compare how all Medicare Part D PDP plans in MD cover OXYBUTYNIN CHLORIDE SYRUP USP 5MG/5ML 5 ML UNIT DOSE CUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OXYCODONE HCL 15MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL 15MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE HCL ER TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:4 /1Days |
OXYCODONE HCL ER TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL ER TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:4 /1Days |
OXYCODONE HCL ER TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL ER TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:4 /1Days |
OXYCODONE HCL ER TABLETS 80MG 100 BOT ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL ER TABLETS 80MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:4 /1Days |
OXYCODONE HCL TABLET 30MG (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL TABLET 30MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OXYCODONE HCL-IBUPROFEN 400MG-5MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HCL-IBUPROFEN 400MG-5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | Q:4 /1Days |
OXYCODONE HYDROCHLORIDE TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HYDROCHLORIDE TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE HYDROCHLORIDE TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE HYDROCHLORIDE TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
OXYCODONE/ASA 4.88/325 TABLET ![Compare how all Medicare Part D PDP plans in MD cover OXYCODONE/ASA 4.88/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$11.00 | $22.00 | None |
OXYCONTIN 10MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 10MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYCONTIN 15MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 15MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYCONTIN 20MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 20MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYCONTIN 30MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 30MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYCONTIN 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCONTIN 60MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 60MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYCONTIN 80MG TABLET SA ![Compare how all Medicare Part D PDP plans in MD cover OXYCONTIN 80MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | Q:4 /1Days |
OXYTROL 3.9MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in MD cover OXYTROL 3.9MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$32.00 | $64.00 | None |