2009 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Premier (S5810-200-0)
Benefit Details
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The Aetna Medicare Rx Premier (S5810-200-0) Formulary Drugs Starting with the Letter I in CMS PDP Region 30 which includes: OR WA
|
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBU TABLET 600MG (500 CT) ![Compare how all Medicare Part D PDP plans in OR cover IBU TABLET 600MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
IBU TABLET 800MG (500 CT) ![Compare how all Medicare Part D PDP plans in OR cover IBU TABLET 800MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
IBUPROFEN 100MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in OR cover IBUPROFEN 100MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IBUPROFEN 400MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IBUPROFEN 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
IDAMYCIN PFS 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover IDAMYCIN PFS 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IDARUBICIN HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover IDARUBICIN HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IFEX 1GM VIAL ![Compare how all Medicare Part D PDP plans in OR cover IFEX 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IFEX 3GM VIAL ![Compare how all Medicare Part D PDP plans in OR cover IFEX 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IFEX/MESNEX KIT 1 GM/VIL 1 GM/ ![Compare how all Medicare Part D PDP plans in OR cover IFEX/MESNEX KIT 1 GM/VIL 1 GM/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IFOSFAMIDE 1GM VIAL ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IFOSFAMIDE 1GM/ 20ML VIAL 20ML ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE 1GM/ 20ML VIAL 20ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IFOSFAMIDE 3GM VIAL ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IFOSFAMIDE 3GM/ 60ML VIAL 60ML ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE 3GM/ 60ML VIAL 60ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in OR cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IMDUR 120MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover IMDUR 120MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IMDUR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover IMDUR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IMDUR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover IMDUR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMIPRAMINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMIPRAMINE PAMOATE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE PAMOATE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE PAMOATE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE PAMOATE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover IMIPRAMINE PAMOATE 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IMITREX 100MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:18 /30Days |
IMITREX 20MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 20MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:4 /1Days |
IMITREX 25MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:18 /30Days |
IMITREX 4MG/0.5ML KIT REFILL ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 4MG/0.5ML KIT REFILL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:4 /30Days |
IMITREX 50MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:18 /30Days |
IMITREX 5MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 5MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:1 /1Days |
IMITREX 6MG/0.5ML SYRNG KIT ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 6MG/0.5ML SYRNG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMITREX 6MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover IMITREX 6MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:5 /30Days |
IMMU GLOBULIN GAMMA (IGG) 12G VIAL ![Compare how all Medicare Part D PDP plans in OR cover IMMU GLOBULIN GAMMA (IGG) 12G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
IMMU GLOBULIN GAMMA (IGG) 6G VIAL ![Compare how all Medicare Part D PDP plans in OR cover IMMU GLOBULIN GAMMA (IGG) 6G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
IMOVAX RABIES VACCINE 2.5UNT/ML ![Compare how all Medicare Part D PDP plans in OR cover IMOVAX RABIES VACCINE 2.5UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | P |
IMURAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IMURAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
INCRELEX 40MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover INCRELEX 40MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
INDAPAMIDE 1.25MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in OR cover INDAPAMIDE 1.25MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
INDAPAMIDE 2.5MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in OR cover INDAPAMIDE 2.5MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
INDERAL LA 120MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDERAL LA 120MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
INDERAL LA 160MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDERAL LA 160MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
INDERAL LA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDERAL LA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDERAL LA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDERAL LA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
INDOCIN 25MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in OR cover INDOCIN 25MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INDOCIN SR 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in OR cover INDOCIN SR 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INDOMETHACIN 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDOMETHACIN 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
INDOMETHACIN 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INDOMETHACIN 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
INDOMETHACIN 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in OR cover INDOMETHACIN 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
INFANRIX VACCINE VIAL 25-10UNT/.5ML ![Compare how all Medicare Part D PDP plans in OR cover INFANRIX VACCINE VIAL 25-10UNT/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
INFUMORPH 10MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in OR cover INFUMORPH 10MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
INFUMORPH 25MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in OR cover INFUMORPH 25MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
INNOHEP 20000UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover INNOHEP 20000UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INNOPRAN XL (PROPRANOLOL HCL) 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in OR cover INNOPRAN XL (PROPRANOLOL HCL) 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INNOPRAN XL (PROPRANOLOL HCL) 80MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in OR cover INNOPRAN XL (PROPRANOLOL HCL) 80MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
INSPRA 25MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover INSPRA 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INSPRA 50MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover INSPRA 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INTAL INH AER 800MCG ![Compare how all Medicare Part D PDP plans in OR cover INTAL INH AER 800MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
INTAL NEBULIZER SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover INTAL NEBULIZER SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | P |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTERFERON ALFACON-1 VIAL 15MCG-0.5ML ![Compare how all Medicare Part D PDP plans in OR cover INTERFERON ALFACON-1 VIAL 15MCG-0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTERFERON ALFACON-1 VIAL 9MCG-0.3ML ![Compare how all Medicare Part D PDP plans in OR cover INTERFERON ALFACON-1 VIAL 9MCG-0.3ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRALIPID 10% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in OR cover INTRALIPID 10% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INTRALIPID 20% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in OR cover INTRALIPID 20% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INTRALIPID IV FAT EMULSION ![Compare how all Medicare Part D PDP plans in OR cover INTRALIPID IV FAT EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG ![Compare how all Medicare Part D PDP plans in OR cover INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INTRON A 10MMU INJ PEN ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 10MMU INJ PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 10MMU VIAL ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 10MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 10MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 10MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 18MMU VIAL ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 18MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 3MMU INJECTION PEN ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 3MMU INJECTION PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 50MMU VIAL ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 50MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 5MMU MULTIDOSE PEN ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 5MMU MULTIDOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in OR cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in OR cover INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in OR cover INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in OR cover INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:1 /1Days |
INVERSINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover INVERSINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
INVIRASE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover INVIRASE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IONOSOL B-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover IONOSOL B-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IONOSOL T-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover IONOSOL T-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IOPIDINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in OR cover IOPIDINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in OR cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IPLEX 36MG/0.6ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover IPLEX 36MG/0.6ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in OR cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
IPRATROPIUM BROMIDE 21MCG AEROSOL SPRAY ![Compare how all Medicare Part D PDP plans in OR cover IPRATROPIUM BROMIDE 21MCG AEROSOL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IPRATROPIUM BROMIDE 42MCG AEROSOL SPRAY ![Compare how all Medicare Part D PDP plans in OR cover IPRATROPIUM BROMIDE 42MCG AEROSOL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
IPRATROPIUM BROMIDE INHALATION SOLUTION 0.02% 60 X 2.5ML VIALSD ![Compare how all Medicare Part D PDP plans in OR cover IPRATROPIUM BROMIDE INHALATION SOLUTION 0.02% 60 X 2.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION SOLUTION 0.5MG/3ML 33 CRTN ![Compare how all Medicare Part D PDP plans in OR cover IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION SOLUTION 0.5MG/3ML 33 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
IQUIX 1.5% DROPS ![Compare how all Medicare Part D PDP plans in OR cover IQUIX 1.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
IRESSA 250MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover IRESSA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
IRINOTECAN HCL INJECTION 20MG ![Compare how all Medicare Part D PDP plans in OR cover IRINOTECAN HCL INJECTION 20MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ISMO 20MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISMO 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISO GENTAMICIN 100MG/100ML ![Compare how all Medicare Part D PDP plans in OR cover ISO GENTAMICIN 100MG/100ML.](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 |
ISO GENTAMICIN 120MG/100ML ![Compare how all Medicare Part D PDP plans in OR cover ISO GENTAMICIN 120MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOCHRON 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover ISOCHRON 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOLYTE H IN 5% DEXTROSE ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE H IN 5% DEXTROSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOLYTE M IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE M IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOLYTE S PH 7.4 SOLUTION FOR INJECTION ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE S PH 7.4 SOLUTION FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOLYTE S IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE S IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOLYTE S SOLUTION FOR INJECTION ![Compare how all Medicare Part D PDP plans in OR cover ISOLYTE S SOLUTION FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISONARIF 300-150MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover ISONARIF 300-150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISONIAZID 100MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISONIAZID 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISONIAZID 300MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISONIAZID 300MG 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 |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in OR cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISONIAZID INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in OR cover ISONIAZID INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOPTIN SR 120MG ![Compare how all Medicare Part D PDP plans in OR cover ISOPTIN SR 120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:1 /1Days |
ISOPTIN SR 180MG ![Compare how all Medicare Part D PDP plans in OR cover ISOPTIN SR 180MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
ISOPTIN SR 240MG (500 Count) ![Compare how all Medicare Part D PDP plans in OR cover ISOPTIN SR 240MG (500 Count).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
ISORDIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISORDIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISORDIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISORDIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ISOSORBIDE DN 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE DN 2.5MG TABLET SL ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 2.5MG TABLET SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE DN 20MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE DN 30MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 30MG 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 |
ISOSORBIDE DN 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOSORBIDE DN 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE DN 5MG TABLET SL ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE DN 5MG TABLET SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE MN 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE MN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE MONONITRATE 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOSORBIDE MONONITRATE TABLET ER 60MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISOSORBIDE MONONITRATE TABLET ER 60MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOTON GENTAMICIN 60MG/100ML ![Compare how all Medicare Part D PDP plans in OR cover ISOTON GENTAMICIN 60MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in OR cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
ISOTON GENTAMICIN 80MG/50ML ![Compare how all Medicare Part D PDP plans in OR cover ISOTON GENTAMICIN 80MG/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:4 /1Days |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:4 /1Days |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in OR cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
ITRACONAZOLE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover ITRACONAZOLE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
IVEEGAM EN INJ 5GM HU ![Compare how all Medicare Part D PDP plans in OR cover IVEEGAM EN INJ 5GM HU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |