2009 Medicare Part D Plan Formulary Information |
UnitedHealth Rx Basic (S5921-302-0)
Benefit Details
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The UnitedHealth Rx Basic (S5921-302-0) Formulary Drugs Starting with the Letter V in CMS PDP Region 18 which includes: MO
|
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 MO cover VAGIFEM 25MCG VAGINAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VALCYTE 450MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VALCYTE 450MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VALPROATE SOD 500MG/5ML VL ![Compare how all Medicare Part D PDP plans in MO cover VALPROATE SOD 500MG/5ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VALPROIC ACID 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover VALPROIC ACID 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT ![Compare how all Medicare Part D PDP plans in MO cover VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VALTREX 1GM CAPLET (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover VALTREX 1GM CAPLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VALTREX 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VALTREX 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VANACET 5/500 TABLET ![Compare how all Medicare Part D PDP plans in MO cover VANACET 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VANCOCIN HCL 125MG PULVULE ![Compare how all Medicare Part D PDP plans in MO cover VANCOCIN HCL 125MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | P |
VANCOCIN HCL 1G/200ML BAG ![Compare how all Medicare Part D PDP plans in MO cover VANCOCIN HCL 1G/200ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | 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 MO cover VANCOCIN HCL 250MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | P |
VANCOCIN HCL 500MG/100ML ![Compare how all Medicare Part D PDP plans in MO cover VANCOCIN HCL 500MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VANCOMYCIN 500MG A/V VIAL ![Compare how all Medicare Part D PDP plans in MO cover VANCOMYCIN 500MG A/V VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VANCOMYCIN 5GM VIAL ![Compare how all Medicare Part D PDP plans in MO cover VANCOMYCIN 5GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VANCOMYCIN HCL 10GM VIAL ![Compare how all Medicare Part D PDP plans in MO cover VANCOMYCIN HCL 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in MO cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VANOS 0.1% CREAM ![Compare how all Medicare Part D PDP plans in MO cover VANOS 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VANTAS IMPLANT 50MG 1 IMPLANT VIAL ![Compare how all Medicare Part D PDP plans in MO cover VANTAS IMPLANT 50MG 1 IMPLANT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VAQTA 25 UNITS/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VAQTA 25 UNITS/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VAQTA HEPATITIS A VACCINE INACTIVATED ADULT 50UNITS/1MLVIAL BOX ![Compare how all Medicare Part D PDP plans in MO cover VAQTA HEPATITIS A VACCINE INACTIVATED ADULT 50UNITS/1MLVIAL BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in MO cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VASERETIC 10MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VASERETIC 10MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VECTIBIX SINGLE USE VIAL INJECTION 200MG/10ML ![Compare how all Medicare Part D PDP plans in MO cover VECTIBIX SINGLE USE VIAL INJECTION 200MG/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | P |
VEETIDS 125MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in MO cover VEETIDS 125MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VEETIDS 250MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VEETIDS 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VEETIDS 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VEETIDS 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VELCADE 3.5MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover VELCADE 3.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK) ![Compare how all Medicare Part D PDP plans in MO cover VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VENLAFAXINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VENLAFAXINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VENLAFAXINE HCL 37.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL 37.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VENLAFAXINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENLAFAXINE HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VENLAFAXINE HCL ER TAB ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL ER TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:62 /31Days |
VENLAFAXINE HCL ER TAB 225 MG ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL ER TAB 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:31 /31Days |
VENLAFAXINE HCL ER TAB 37.5 MG ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL ER TAB 37.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:93 /31Days |
VENLAFAXINE HCL ER TAB 75 MG ![Compare how all Medicare Part D PDP plans in MO cover VENLAFAXINE HCL ER TAB 75 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:93 /31Days |
VENTAVIS INHALATION SOLUTION 10MCG AMPULE ![Compare how all Medicare Part D PDP plans in MO cover VENTAVIS INHALATION SOLUTION 10MCG AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | P |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in MO cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VERAMYST 27.5MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in MO cover VERAMYST 27.5MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:10 /31Days |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL 120MG TABLET SA ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 120MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAPAMIL 2.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 2.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL HCL 18OMG ER TABLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL HCL 18OMG ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL HCL 240MG TABLET SA ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL HCL 240MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERAPAMIL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VERAPAMIL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VERDESO 0.05% FOAM ![Compare how all Medicare Part D PDP plans in MO cover VERDESO 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in MO cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT ![Compare how all Medicare Part D PDP plans in MO cover VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VESICARE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VESICARE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VESICARE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover VESICARE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VEXOL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in MO cover VEXOL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VFEND 200MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VFEND 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VFEND 40MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in MO cover VFEND 40MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VFEND 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VFEND 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VFEND IV 200MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover VFEND IV 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIBRAMYCIN 25MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in MO cover VIBRAMYCIN 25MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIBRAMYCIN 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MO cover VIBRAMYCIN 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
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 MO cover VIDAZA 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIDEX 2GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in MO cover VIDEX 2GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIDEX 4GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in MO cover VIDEX 4GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MO cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in MO cover VIGAMOX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VINBLASTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINBLASTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VINBLASTINE SULF 10MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINBLASTINE SULF 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$7.00 | $0.00 | None |
VINORELBINE 10MG/ML VIAL 5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINORELBINE 10MG/ML VIAL 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VINORELBINE 50MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VINORELBINE 50MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VINORELBINE INJECTION 50MG/5ML ![Compare how all Medicare Part D PDP plans in MO cover VINORELBINE INJECTION 50MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIOKASE 16 TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIOKASE 16 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIOKASE POWDER ![Compare how all Medicare Part D PDP plans in MO cover VIOKASE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIOKASE TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIOKASE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIRACEPT 50MG/GM ORAL POWDER ![Compare how all Medicare Part D PDP plans in MO cover VIRACEPT 50MG/GM ORAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIRAMUNE 200MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIRAMUNE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in MO cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIRAZOLE 6GM VIAL ![Compare how all Medicare Part D PDP plans in MO cover VIRAZOLE 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIREAD 300MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIREAD 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VISICOL 1.5GM TABLET ![Compare how all Medicare Part D PDP plans in MO cover VISICOL 1.5GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VISTIDE 75MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VISTIDE 75MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
VIVACTIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIVACTIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIVACTIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VIVACTIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VIVAGLOBIN SOL 160MG/ML 10ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover VIVAGLOBIN SOL 160MG/ML 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | P |
VIVELLE-DOT 0.025MG PATCH ![Compare how all Medicare Part D PDP plans in MO cover VIVELLE-DOT 0.025MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIVELLE-DOT 0.0375MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in MO cover VIVELLE-DOT 0.0375MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIVELLE-DOT 0.05MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in MO cover VIVELLE-DOT 0.05MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in MO cover VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIVELLE-DOT 0.1MG PATCH 8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in MO cover VIVELLE-DOT 0.1MG PATCH 8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VIVITROL INJ 380MG ![Compare how all Medicare Part D PDP plans in MO cover VIVITROL INJ 380MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Specialty (Generic, Brand) |
33% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VOLTAREN 1% GEL ![Compare how all Medicare Part D PDP plans in MO cover VOLTAREN 1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | None |
VOPAC 650MG-30MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover VOPAC 650MG-30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Generic and Preferred Brand |
$35.00 | $90.00 | None |
VYTORIN 10/10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover VYTORIN 10/10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VYTORIN 10/20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover VYTORIN 10/20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VYTORIN 10/40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover VYTORIN 10/40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VYTORIN 10/80MG TABLET 2500 BOT ![Compare how all Medicare Part D PDP plans in MO cover VYTORIN 10/80MG TABLET 2500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | S Q:31 /31Days |
VYVANSE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover VYVANSE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:62 /31Days |
VYVANSE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover VYVANSE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:31 /31Days |
VYVANSE 70MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover VYVANSE 70MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Other Non Preferred (Generic, Brand) |
$91.00 | $258.00 | Q:31 /31Days |