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2009 Medicare Part D Plan (PDP Only) Formulary Browser

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Select your search style and criteria below or use this example to get started
Search Criteria
PDP Plans
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HIP Part D New York (S5741-001-0)
Tier 1 (1668)
Tier 2 (762)
Tier 3 (2817)
Tier 4 (128)

Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2009 Medicare Part D Plan Formulary Information
HIP Part D New York (S5741-001-0)
Benefit Details  
The HIP Part D New York (S5741-001-0)
Formulary Drugs Starting with the Letter E

in CMS PDP Region 3 which includes: NY
Drugs Starting with Letter E

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
E.E.S. 200MG/5ML GRANULES   3 Tier 3 40%40%Q:400
/15Days
E.E.S. 200MG/5ML SUSPENSION   3 Tier 3 40%40%Q:960
/30Days
E.E.S. 400 TABLET 400MG   1 Tier 1 $5.00$10.00None
E.E.S. 400MG/5ML SUSPENSION   3 Tier 3 40%40%Q:960
/30Days
EC-NAPROSYN 375MG TABLET EC   3 Tier 3 40%40%None
EC-NAPROSYN 500MG TABLET EC   3 Tier 3 40%40%None
ECONAZOLE NITRATE 1% CREAM 85GM TUBE   1 Tier 1 $5.00$10.00Q:170
/30Days
ECONOPRED PLUS 1% EYE DROPS   3 Tier 3 40%40%Q:20
/30Days
ED DOXY-CAPS 100MG CAPSULE   1 Tier 1 $5.00$10.00None
ED K+10 TABLET   1 Tier 1 $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EDECRIN 25MG TABLET (100 CT)   3 Tier 3 40%40%None
EDECRIN SODIUM 50MG VIAL   3 Tier 3 40%40%P
EFFEXOR 100MG TABLET   3 Tier 3 40%40%None
EFFEXOR 25MG TABLET (60 CT)   3 Tier 3 40%40%None
EFFEXOR 37.5MG CAPSULE ER (90 CT)   2 Tier 2 25%25%None
EFFEXOR 37.5MG TABLET   3 Tier 3 40%40%None
EFFEXOR 50MG TABLET (30 CT)   3 Tier 3 40%40%None
EFFEXOR 75MG TABLET (30 CT)   3 Tier 3 40%40%None
EFFEXOR XR 150MG CAPSULE ER 15 CAPSULES BOT   2 Tier 2 25%25%None
EFFEXOR XR 75MG CAPSULE ER 15 CAPSULES BOT   2 Tier 2 25%25%None
EFUDEX 2% SOLUTION   3 Tier 3 40%40%Q:50
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EFUDEX 5% CREAM   3 Tier 3 40%40%Q:80
/30Days
EFUDEX 5% SOLUTION   3 Tier 3 40%40%Q:50
/30Days
EFUDEX OCCLUSION PACK   3 Tier 3 40%40%None
ELAPRASE 6MG/3ML VIAL   3 Tier 3 40%40%P
ELDEPRYL 5MG CAPSULE   3 Tier 3 40%40%None
ELESTAT 0.05% EYE DROPS   2 Tier 2 25%25%Q:10
/30Days
ELESTRIN 0.87G GEL IN METERED-DOSE PUMP   3 Tier 3 40%40%None
ELIDEL 1% CREAM   2 Tier 2 25%25%Q:60
/30Days
ELIGARD 22.5MG SYRINGE   2 Tier 2 25%25%P Q:1
/90Days
ELIGARD 30MG SYRINGE   2 Tier 2 25%25%P Q:1
/120Days
ELIGARD 45MG SYRINGE   2 Tier 2 25%25%P Q:1
/180Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ELIGARD 7.5MG SYRINGE   2 Tier 2 25%25%P Q:1
/30Days
ELIMITE 5% CREAM   3 Tier 3 40%40%Q:120
/30Days
ELITEK 1.5MG VIAL   3 Tier 3 40%40%P Q:10
/5Days
ELITEK 7.5MG VIAL   3 Tier 3 40%40%P Q:5
/5Days
ELIXOPHYLLIN 80MG/15ML ELIX   3 Tier 3 40%40%Q:300
/5Days
ELLENCE 2MG/ML VIAL   3 Tier 3 40%40%P
ELMIRON 100MG CAPSULE   3 Tier 3 40%40%None
ELOCON 0.1% CREAM   3 Tier 3 40%40%Q:90
/30Days
ELOCON 0.1% LOTION   3 Tier 3 40%40%Q:120
/30Days
ELOCON 0.1% OINTMENT   3 Tier 3 40%40%Q:90
/30Days
ELOXATIN 100MG/20ML VIAL   3 Tier 3 40%40%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ELOXATIN 50MG/10ML VIAL   3 Tier 3 40%40%P
ELSPAR INJ 10000UNT   3 Tier 3 40%40%P Q:70
/10Days
EMADINE 0.05% EYE DROPS   3 Tier 3 40%40%Q:10
/30Days
EMCYT 140MG CAPSULE   2 Tier 2 25%25%None
EMEND 125MG CAPSULE   2 Tier 2 25%25%None
EMEND 40MG CAPSULE   2 Tier 2 25%25%None
EMEND 80MG CAPSULE   2 Tier 2 25%25%None
EMEND TRIFOLD PACK   2 Tier 2 25%25%None
EMLA CREAM 25MG/25MG   3 Tier 3 40%40%Q:60
/30Days
EMLA CREAM W/TEGADERM 25MG/25MG   3 Tier 3 40%40%None
EMSAM 12MG/24 HOURS PATCH   3 Tier 3 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EMSAM 6MG/24 HOURS PATCH   3 Tier 3 40%40%None
EMSAM 9MG/24 HOURS PATCH   3 Tier 3 40%40%None
EMTRIVA 10MG/ML SOLUTION   2 Tier 2 25%25%Q:340
/5Days
EMTRIVA 200MG CAPSULE   2 Tier 2 25%25%None
ENABLEX 15MG TABLET   3 Tier 3 40%40%None
ENABLEX 7.5MG TABLET   3 Tier 3 40%40%None
ENALAPRIL MALEATE 10MG TABLET (100 CT)   1 Tier 1 $5.00$10.00None
ENALAPRIL MALEATE 2.5MG TABLET   1 Tier 1 $5.00$10.00None
ENALAPRIL MALEATE 20MG TABLET (1000 CT)   1 Tier 1 $5.00$10.00None
ENALAPRIL MALEATE 5MG TABLET   1 Tier 1 $5.00$10.00None
ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT)   1 Tier 1 $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT)   1 Tier 1 $5.00$10.00None
ENBREL 50MG/ML SURECLICK SYR   4 Tier 4 25%25%Q:3
/5Days
ENBREL INJECTION 50MG/ML SYR   4 Tier 4 25%25%Q:3
/5Days
ENBREL INJECTION KIT 25MG 1 DOSE TRAY PKGCOM   4 Tier 4 25%25%Q:8
/5Days
ENDOCET 10/650MG TABLET   1 Tier 1 $5.00$10.00None
ENDOCET 10MG-325MG TABLET   1 Tier 1 $5.00$10.00None
ENDOCET 5/325 TABLET   1 Tier 1 $5.00$10.00None
ENDOCET 7.5-325MG TABLET   1 Tier 1 $5.00$10.00None
ENDOCET 7.5/500MG TABLET   1 Tier 1 $5.00$10.00None
ENDOMETRIN PROGESTERONE MICRONIZED 100MG INSERT   3 Tier 3 40%40%None
ENGERIX-B 10MCG 10 X 0.5ML VIALSD   2 Tier 2 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ENGERIX-B 10MCG/0.5ML SYRN   2 Tier 2 25%25%P
ENGERIX-B 20MCG/ML SYRINGE   2 Tier 2 25%25%P
ENJUVIA 0.3MG TABLET   3 Tier 3 40%40%None
ENJUVIA 0.45MG TABLET   3 Tier 3 40%40%None
ENJUVIA 0.625MG TABLET   3 Tier 3 40%40%None
ENJUVIA 0.9MG TABLET   3 Tier 3 40%40%None
ENJUVIA 1.25MG TABLET   3 Tier 3 40%40%None
ENPRESSE-28 TABLET   3 Tier 3 40%40%Q:28
/28Days
ENTOCORT EC 3MG CAPSULE   2 Tier 2 25%25%None
ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL   1 Tier 1 $5.00$10.00None
ENZYMAX 500MG TABLET   3 Tier 3 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EPIDUO GEL 0.1;2.5%;% 45 TRADE SIZE TUBE   3 Tier 3 40%40%Q:90
/30Days
EPINEPHRINE 0.1MG/ML ABBJCT   3 Tier 3 40%40%P
EPIPEN 0.3MG AUTO-INJECTOR   3 Tier 3 40%40%Q:1
/30Days
EPIPEN JR 0.15MG AUTO-INJCT   3 Tier 3 40%40%Q:1
/30Days
EPIRUBICIN HCL INJECTION SOLUTION 2MG 1 X 25ML VIAL   3 Tier 3 40%40%P
EPITOL 200MG TABLET   1 Tier 1 $5.00$10.00None
EPIVIR 10MG/ML ORAL SOLUTION   2 Tier 2 25%25%Q:480
/15Days
EPIVIR 150MG TABLET   2 Tier 2 25%25%None
EPIVIR 300MG TABLET   2 Tier 2 25%25%None
EPIVIR HBV 100MG TABLET   2 Tier 2 25%25%None
EPIVIR HBV 25MG/5ML TUBEX   2 Tier 2 25%25%Q:480
/15Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EPLERENONE 25MG TABS   3 Tier 3 40%40%None
EPLERENONE 50MG TABS   3 Tier 3 40%40%None
EPOGEN 10000U/ML VIAL MDV   3 Tier 3 40%40%P
EPOGEN 2000U/ML VIAL SDV   3 Tier 3 40%40%P
EPOGEN 3000U/ML VIAL SDV   3 Tier 3 40%40%P
EPOGEN 4000U/ML VIAL SDV   3 Tier 3 40%40%P
EPOGEN INJECTION 20000U 10 X 1ML CRTN   3 Tier 3 40%40%P
EPOGEN INJECTION 40000U 10 X 4ML VIALS VIALSD   3 Tier 3 40%40%P
EPZICOM TABLET   2 Tier 2 25%25%None
EQUAGESIC TABLET   3 Tier 3 40%40%None
EQUETRO 100MG CAPSULE   3 Tier 3 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EQUETRO 200MG CAPSULE   3 Tier 3 40%40%None
EQUETRO 300MG CAPSULE   3 Tier 3 40%40%None
ERAXIS 100MG VIAL   3 Tier 3 40%40%P
ERAXIS 50MG VIAL   3 Tier 3 40%40%P Q:32
/14Days
ERBITUX 100MG/50ML VIAL   3 Tier 3 40%40%P
ERGOLOID MESYLATES 1MG TABLET (500 CT)   1 Tier 1 $5.00$10.00None
ERGOMAR SUBLINGUAL TABLET 2MG   2 Tier 2 25%25%None
ERGOTAMINE-CAFFEINE 1-100MG TABLET   1 Tier 1 $5.00$10.00Q:40
/28Days
ERRIN 0.35MG TABLET   1 Tier 1 $5.00$10.00Q:28
/28Days
ERTACZO 2% CREAM   2 Tier 2 25%25%Q:120
/30Days
ERY 2% SWAB MEDICATED   3 Tier 3 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ERY-TAB 250MG TABLET EC   3 Tier 3 40%40%None
ERY-TAB 333MG TABLET EC   3 Tier 3 40%40%None
ERY-TAB 500MG TABLET EC   3 Tier 3 40%40%None
ERYDERM 2% TOP SOLUTION   3 Tier 3 40%40%None
ERYGEL 2% GEL   3 Tier 3 40%40%Q:120
/30Days
ERYPED 100MG/2.5ML DROPS   2 Tier 2 25%25%Q:100
/5Days
ERYPED 400MG/5ML GRANULES   3 Tier 3 40%40%Q:400
/30Days
ERYPED-200MG/5ML GRANULES   3 Tier 3 40%40%Q:400
/15Days
ERYTHROCIN 250MG FILMTAB   3 Tier 3 40%40%None
ERYTHROCIN 500MG ADDVNT VL   3 Tier 3 40%40%P
ERYTHROCIN 500MG FILMTAB   1 Tier 1 $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ERYTHROCIN 500MG VIAL   3 Tier 3 40%40%P
ERYTHROCIN LACTOBIONATE IV POWDER FOR INJECTION   3 Tier 3 40%40%P
ERYTHROMYCIN 2% GEL   1 Tier 1 $5.00$10.00Q:120
/30Days
ERYTHROMYCIN 2% SOLUTION   1 Tier 1 $5.00$10.00None
ERYTHROMYCIN 200MG/5ML SUSP   1 Tier 1 $5.00$10.00Q:946
/30Days
ERYTHROMYCIN 250MG CAP EC   1 Tier 1 $5.00$10.00None
ERYTHROMYCIN 250MG FILMTAB   1 Tier 1 $5.00$10.00None
ERYTHROMYCIN 400MG/5ML SUSP   1 Tier 1 $5.00$10.00Q:946
/30Days
ERYTHROMYCIN 500MG FILMTAB   1 Tier 1 $5.00$10.00None
ERYTHROMYCIN ETHYLSUCCINATE 400MG TABLET (500 CT)   1 Tier 1 $5.00$10.00None
ERYTHROMYCIN OPHTHALMIC OINTMENT 5MG 1/8 OZ TUBE   1 Tier 1 $5.00$10.00Q:7
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ERYTHROMYCIN-BENZOYL PEROXIDE 3-5% GEL   1 Tier 1 $5.00$10.00Q:46
/30Days
ERYTHROMYCIN/SULFISOX SUSP   1 Tier 1 $5.00$10.00Q:300
/15Days
ESTRACE 0.5MG TABLET   3 Tier 3 40%40%None
ESTRACE 2MG TABLET   3 Tier 3 40%40%None
ESTRACE TABLET 1MG (100 CT)   3 Tier 3 40%40%None
ESTRACE VAG CREAM 0.1MG/GM   2 Tier 2 25%25%None
ESTRADERM 0.05MG/24H PATCH TRANSDERMAL SEMIWEEKLY   2 Tier 2 25%25%Q:8
/28Days
ESTRADERM 0.1MG/24HR PATCH TRANSDERMAL SEMIWEEKLY   2 Tier 2 25%25%Q:8
/28Days
ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY   1 Tier 1 $5.00$10.00Q:4
/28Days
ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY   1 Tier 1 $5.00$10.00Q:4
/28Days
ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY   1 Tier 1 $5.00$10.00Q:4
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ESTRADIOL 0.05MG/DAY PATCH   1 Tier 1 $5.00$10.00Q:4
/28Days
ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY   1 Tier 1 $5.00$10.00Q:4
/28Days
ESTRADIOL 0.1MG/DAY PATCH   1 Tier 1 $5.00$10.00Q:4
/28Days
ESTRADIOL 0.5MG TABLET   1 Tier 1 $5.00$10.00None
ESTRADIOL 2MG TABLET   1 Tier 1 $5.00$10.00None
ESTRADIOL TABLET 1MG (500 CT)   1 Tier 1 $5.00$10.00None
ESTRADIOL VALERATE INJECTION   3 Tier 3 40%40%P
ESTRADIOL VALERATE INJECTION   3 Tier 3 40%40%P
ESTRADIOL VALERATE INJECTION   3 Tier 3 40%40%P
ESTRADIOL-NORETH 1.0-0.5MG TABLET   1 Tier 1 $5.00$10.00None
ESTRASORB 2.5MG 56 POU   3 Tier 3 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ESTRING 2MG VAGINAL RING   2 Tier 2 25%25%Q:1
/90Days
ESTROGEL 0.06% GEL   3 Tier 3 40%40%None
ESTROPIPATE 0.625 TABLET   1 Tier 1 $5.00$10.00None
ESTROPIPATE 1.25 TABLET   1 Tier 1 $5.00$10.00None
ESTROPIPATE 2.5 TABLET   1 Tier 1 $5.00$10.00None
ESTROSTEP FE-28 TABLET   2 Tier 2 25%25%Q:28
/28Days
ETHAMBUTOL HCL 100MG TABLET   1 Tier 1 $5.00$10.00None
ETHAMBUTOL HCL 400MG TABLET (100 CT)   1 Tier 1 $5.00$10.00None
ETHOSUXIMIDE 250MG CAPSULE   1 Tier 1 $5.00$10.00None
ETHOSUXIMIDE 250MG/5ML SYRP   1 Tier 1 $5.00$10.00None
ETHYOL POWDER FOR INJECTION 500MG 3 X 10ML VILSU CRTN   3 Tier 3 40%40%P Q:15
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ETIDRONATE DISODIUM 200MG TABLET   1 Tier 1 $5.00$10.00None
ETIDRONATE DISODIUM 400MG TABLET (60 CT)   1 Tier 1 $5.00$10.00None
ETODOLAC 200MG CAPSULE   1 Tier 1 $5.00$10.00None
ETODOLAC 300MG CAPSULE   1 Tier 1 $5.00$10.00None
ETODOLAC 400MG TABLET (500 CT)   1 Tier 1 $5.00$10.00None
ETODOLAC 400MG TABLET SR 24HR   1 Tier 1 $5.00$10.00None
ETODOLAC 500MG TABLET (100 CT)   1 Tier 1 $5.00$10.00None
ETODOLAC 500MG TABLET SR 24HR   1 Tier 1 $5.00$10.00None
ETODOLAC 600MG TABLET SR 24HR   1 Tier 1 $5.00$10.00None
ETOPOPHOS 100MG VIAL   3 Tier 3 40%40%P
ETOPOSIDE INJECTION 20MG 25ML VIALMD   3 Tier 3 40%40%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EURAX 10% CREAM   3 Tier 3 40%40%Q:120
/30Days
EURAX 10% LOTION   3 Tier 3 40%40%Q:908
/30Days
EVAMIST 1.53/SPRAY SPRAY NON-AEROSOL   3 Tier 3 40%40%None
EVISTA 60MG TABLET (30 CT)   2 Tier 2 25%25%Q:30
/30Days
EVOCLIN 1% FOAM   3 Tier 3 40%40%Q:200
/30Days
EVOXAC 30MG CAPSULE   3 Tier 3 40%40%None
EXELDERM 1% CREAM   3 Tier 3 40%40%Q:60
/30Days
EXELDERM 1% SOLUTION   3 Tier 3 40%40%Q:60
/30Days
EXELON 1.5MG CAPSULE   2 Tier 2 25%25%None
EXELON 2MG/ML ORAL SOLUTION   2 Tier 2 25%25%Q:240
/30Days
EXELON 3MG CAPSULE   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EXELON 4.5MG CAPSULE   2 Tier 2 25%25%None
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS   3 Tier 3 40%40%None
EXELON 6MG CAPSULE   2 Tier 2 25%25%None
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS   3 Tier 3 40%40%None
EXFORGE 10MG-160MG TABLET   2 Tier 2 25%25%None
EXFORGE 10MG-320MG TABLET   2 Tier 2 25%25%None
EXFORGE 5MG-160MG TABLET   2 Tier 2 25%25%None
EXFORGE 5MG-320MG TABLET   2 Tier 2 25%25%None
EXJADE 125MG TABLET   2 Tier 2 25%25%None
EXJADE 250MG TABLET   2 Tier 2 25%25%None
EXJADE 500MG TABLET   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EXTINA 2% FOAM   3 Tier 3 40%40%None

Chart Legend:

Below are a few notes to help you understand the above 2009 Medicare Part D HIP Part D New York Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $295 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2700) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2009 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.