2009 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Premier (S5810-179-0)
Benefit Details
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The Aetna Medicare Rx Premier (S5810-179-0) Formulary Drugs Starting with the Letter V in CMS PDP Region 9 which includes: SC
|
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VAGIFEM 25MCG VAGINAL TABLET ![Compare how all Medicare Part D PDP plans in SC cover VAGIFEM 25MCG VAGINAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VALCYTE 450MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VALCYTE 450MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VALPROATE SOD 500MG/5ML VL ![Compare how all Medicare Part D PDP plans in SC cover VALPROATE SOD 500MG/5ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VALPROIC ACID 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VALPROIC ACID 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT ![Compare how all Medicare Part D PDP plans in SC cover VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VALTREX 1GM CAPLET (90 CT) ![Compare how all Medicare Part D PDP plans in SC cover VALTREX 1GM CAPLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VALTREX 500MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VALTREX 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VANACET 5/500 TABLET ![Compare how all Medicare Part D PDP plans in SC cover VANACET 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
VANCOCIN HCL 125MG PULVULE ![Compare how all Medicare Part D PDP plans in SC cover VANCOCIN HCL 125MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VANCOCIN HCL 1G/200ML BAG ![Compare how all Medicare Part D PDP plans in SC cover VANCOCIN HCL 1G/200ML BAG.](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 |
VANCOCIN HCL 250MG PULVULE ![Compare how all Medicare Part D PDP plans in SC cover VANCOCIN HCL 250MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VANCOCIN HCL 500MG/100ML ![Compare how all Medicare Part D PDP plans in SC cover VANCOCIN HCL 500MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VANCOMYCIN 500MG A/V VIAL ![Compare how all Medicare Part D PDP plans in SC cover VANCOMYCIN 500MG A/V VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VANCOMYCIN 5GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover VANCOMYCIN 5GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VANCOMYCIN HCL 10GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover VANCOMYCIN HCL 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in SC cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VANOS 0.1% CREAM ![Compare how all Medicare Part D PDP plans in SC cover VANOS 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VANSPAR 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VANSPAR 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VANTAS IMPLANT 50MG 1 IMPLANT VIAL ![Compare how all Medicare Part D PDP plans in SC cover VANTAS IMPLANT 50MG 1 IMPLANT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VANTIN 100MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SC cover VANTIN 100MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VANTIN 200MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in SC cover VANTIN 200MG TABLET (20 CT).](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 |
VAQTA 25 UNITS/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VAQTA 25 UNITS/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | P |
VAQTA HEPATITIS A VACCINE INACTIVATED ADULT 50UNITS/1MLVIAL BOX ![Compare how all Medicare Part D PDP plans in SC cover VAQTA HEPATITIS A VACCINE INACTIVATED ADULT 50UNITS/1MLVIAL BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | P |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in SC cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VASERETIC 10MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VASERETIC 10MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VASOTEC 10MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VASOTEC 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:2 /1Days |
VASOTEC 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VASOTEC 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:2 /1Days |
VASOTEC 20MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VASOTEC 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VASOTEC 5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VASOTEC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:2 /1Days |
VECTIBIX SINGLE USE VIAL INJECTION 200MG/10ML ![Compare how all Medicare Part D PDP plans in SC cover VECTIBIX SINGLE USE VIAL INJECTION 200MG/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VECTICAL OINTMENT 3MCG/GM 100 GM TUBE ![Compare how all Medicare Part D PDP plans in SC cover VECTICAL OINTMENT 3MCG/GM 100 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VEETIDS 125MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in SC cover VEETIDS 125MG/5ML ORAL SUSP.](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 |
VEETIDS 250MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VEETIDS 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
VEETIDS 500MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VEETIDS 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
VELCADE 3.5MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover VELCADE 3.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK) ![Compare how all Medicare Part D PDP plans in SC cover VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VENLAFAXINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:3 /1Days |
VENLAFAXINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:3 /1Days |
VENLAFAXINE HCL 37.5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL 37.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:4 /1Days |
VENLAFAXINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
VENLAFAXINE HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:5 /1Days |
VENLAFAXINE HCL ER TAB ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL ER TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
VENLAFAXINE HCL ER TAB 225 MG ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL ER TAB 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENLAFAXINE HCL ER TAB 37.5 MG ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL ER TAB 37.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
VENLAFAXINE HCL ER TAB 75 MG ![Compare how all Medicare Part D PDP plans in SC cover VENLAFAXINE HCL ER TAB 75 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
VENTAVIS INHALATION SOLUTION 10MCG AMPULE ![Compare how all Medicare Part D PDP plans in SC cover VENTAVIS INHALATION SOLUTION 10MCG AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in SC cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VERAMYST 27.5MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in SC cover VERAMYST 27.5MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
VERAPAMIL 120MG TABLET SA ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 120MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
VERAPAMIL 2.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 2.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | Q:4 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:1 /1Days |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VERAPAMIL HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | Q:4 /1Days |
VERAPAMIL HCL 18OMG ER TABLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL HCL 18OMG ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
VERAPAMIL HCL 240MG TABLET SA ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL HCL 240MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VERAPAMIL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VERAPAMIL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | Q:4 /1Days |
VERDESO 0.05% FOAM ![Compare how all Medicare Part D PDP plans in SC cover VERDESO 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in SC cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VERELAN 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN 120MG CAP PELLET.](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 |
VERELAN 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN 180MG CAP PELLET.](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 |
VERELAN 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VERELAN 360MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN 360MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VERELAN PM 100MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN PM 100MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:1 /1Days |
VERELAN PM 200MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN PM 200MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:2 /1Days |
VERELAN PM 300MG CAP PELLET ![Compare how all Medicare Part D PDP plans in SC cover VERELAN PM 300MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT ![Compare how all Medicare Part D PDP plans in SC cover VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VESANOID 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VESANOID 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VESICARE 10MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VESICARE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VESICARE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in SC cover VESICARE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VEXOL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover VEXOL 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 |
VFEND 200MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VFEND 200MG TABLET.](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 |
VFEND 40MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in SC cover VFEND 40MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
VFEND 50MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VFEND 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
VFEND IV 200MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover VFEND IV 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
VIBRA-TAB S 100MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIBRA-TAB S 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VIBRAMYCIN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VIBRAMYCIN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VIBRAMYCIN 25MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in SC cover VIBRAMYCIN 25MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VIBRAMYCIN 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in SC cover VIBRAMYCIN 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VICODIN 5/500 TABLET ![Compare how all Medicare Part D PDP plans in SC cover VICODIN 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VICODIN ES TABLET 7.5-750 ![Compare how all Medicare Part D PDP plans in SC cover VICODIN ES TABLET 7.5-750.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VICODIN HP TABLET 10-660 ![Compare how all Medicare Part D PDP plans in SC cover VICODIN HP TABLET 10-660.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
VICOPROFEN 200/7.5 TABLET ![Compare how all Medicare Part D PDP plans in SC cover VICOPROFEN 200/7.5 TABLET.](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 |
VIDAZA 100MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover VIDAZA 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VIDEX 2GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in SC cover VIDEX 2GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIDEX 4GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in SC cover VIDEX 4GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in SC cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIDEX EC 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in SC cover VIDEX EC 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIDEX EC 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in SC cover VIDEX EC 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIDEX EC 400MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in SC cover VIDEX EC 400MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover VIGAMOX 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 |
VIMPAT TAB ![Compare how all Medicare Part D PDP plans in SC cover VIMPAT TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:2 /1Days |
VIMPAT TAB ![Compare how all Medicare Part D PDP plans in SC cover VIMPAT TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:2 /1Days |
VIMPAT TABS ![Compare how all Medicare Part D PDP plans in SC cover VIMPAT TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIMPAT TABS ![Compare how all Medicare Part D PDP plans in SC cover VIMPAT TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:6 /1Days |
VINBLASTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINBLASTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
VINBLASTINE SULF 10MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINBLASTINE SULF 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
VINORELBINE 10MG/ML VIAL 5ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINORELBINE 10MG/ML VIAL 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VINORELBINE 50MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VINORELBINE 50MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VINORELBINE INJECTION 50MG/5ML ![Compare how all Medicare Part D PDP plans in SC cover VINORELBINE INJECTION 50MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
VIOKASE 16 TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIOKASE 16 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIOKASE POWDER ![Compare how all Medicare Part D PDP plans in SC cover VIOKASE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIOKASE TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIOKASE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIRACEPT 50MG/GM ORAL POWDER ![Compare how all Medicare Part D PDP plans in SC cover VIRACEPT 50MG/GM ORAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
VIRAMUNE 200MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIRAMUNE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in SC cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VIRAZOLE 6GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover VIRAZOLE 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VIREAD 300MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIREAD 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VIROPTIC 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover VIROPTIC 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 |
VISICOL 1.5GM TABLET ![Compare how all Medicare Part D PDP plans in SC cover VISICOL 1.5GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VISTARIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VISTARIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
VISTARIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VISTARIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VISTIDE 75MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VISTIDE 75MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
VIVACTIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIVACTIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VIVACTIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VIVACTIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VIVAGLOBIN SOL 160MG/ML 10ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover VIVAGLOBIN SOL 160MG/ML 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
VIVELLE-DOT 0.025MG PATCH ![Compare how all Medicare Part D PDP plans in SC cover VIVELLE-DOT 0.025MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:8 /28Days |
VIVELLE-DOT 0.0375MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in SC cover VIVELLE-DOT 0.0375MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:8 /28Days |
VIVELLE-DOT 0.05MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in SC cover VIVELLE-DOT 0.05MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:8 /28Days |
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in SC cover VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:8 /28Days |
VIVELLE-DOT 0.1MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in SC cover VIVELLE-DOT 0.1MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | Q:8 /28Days |
VIVITROL INJ 380MG ![Compare how all Medicare Part D PDP plans in SC cover VIVITROL INJ 380MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P S Q:1 /30Days |
VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in SC cover VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VOLTAREN 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover VOLTAREN 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VOLTAREN 1% GEL ![Compare how all Medicare Part D PDP plans in SC cover VOLTAREN 1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:34 /1Days |
VOLTAREN 75MG TABLET EC ![Compare how all Medicare Part D PDP plans in SC cover VOLTAREN 75MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VOLTAREN-XR 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in SC cover VOLTAREN-XR 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
VOPAC 650MG-30MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover VOPAC 650MG-30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VOSPIRE ER 4MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in SC cover VOSPIRE ER 4MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VOSPIRE ER 8MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in SC cover VOSPIRE ER 8MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
VYTORIN 10/10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in SC cover VYTORIN 10/10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:1 /1Days |
VYTORIN 10/20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in SC cover VYTORIN 10/20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:1 /1Days |
VYTORIN 10/40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in SC cover VYTORIN 10/40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:1 /1Days |
VYTORIN 10/80MG TABLET 2500 BOT ![Compare how all Medicare Part D PDP plans in SC cover VYTORIN 10/80MG TABLET 2500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VYVANSE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VYVANSE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:1 /1Days |
VYVANSE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VYVANSE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:1 /1Days |
VYVANSE 70MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover VYVANSE 70MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P S Q:1 /1Days |