2009 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx - Costco Plus Plan (S5810-167-0)
Benefit Details
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The Aetna Medicare Rx - Costco Plus Plan (S5810-167-0) Formulary Drugs Starting with the Letter A in CMS PDP Region 31 which includes: ID UT
|
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG ![Compare how all Medicare Part D PDP plans in UT cover A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
A-HYDROCORT 100MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover A-HYDROCORT 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
A-METHAPRED 40MG UNIVIAL ![Compare how all Medicare Part D PDP plans in UT cover A-METHAPRED 40MG UNIVIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ABELCENT INJECTION SUSPENSION 5MG/ML ![Compare how all Medicare Part D PDP plans in UT cover ABELCENT INJECTION SUSPENSION 5MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ABILIFY 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ABILIFY 15MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ABILIFY 1MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 1MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:30 /1Days |
ABILIFY 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ABILIFY 2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ABILIFY 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABILIFY 5MG TABLET (OTSUKA) ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY 5MG TABLET (OTSUKA).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ABILIFY DISCMELT 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY DISCMELT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ABILIFY DISCMELT 15MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY DISCMELT 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ABILIFY INJ 9.75MG ![Compare how all Medicare Part D PDP plans in UT cover ABILIFY INJ 9.75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ABRAXANE 100MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ABRAXANE 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ACANYA TOPICAL GEL ![Compare how all Medicare Part D PDP plans in UT cover ACANYA TOPICAL GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACARBOSE 100MG TABLET S ![Compare how all Medicare Part D PDP plans in UT cover ACARBOSE 100MG TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACARBOSE 25MG TABLET S ![Compare how all Medicare Part D PDP plans in UT cover ACARBOSE 25MG TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACARBOSE 50MG TABLET S ![Compare how all Medicare Part D PDP plans in UT cover ACARBOSE 50MG TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACCOLATE 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCOLATE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ACCOLATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCOLATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACCUNEB 0.63MG/3ML INH TUBEX ![Compare how all Medicare Part D PDP plans in UT cover ACCUNEB 0.63MG/3ML INH TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ACCUNEB 1.25MG/3ML INH TUBEX ![Compare how all Medicare Part D PDP plans in UT cover ACCUNEB 1.25MG/3ML INH TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ACCUPRIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCUPRIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ACCUPRIL 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCUPRIL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ACCUPRIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCUPRIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ACCUPRIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCUPRIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ACCURETIC 10-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCURETIC 10-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ACCURETIC 20-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCURETIC 20-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ACCURETIC 20-25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACCURETIC 20-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ACCUTANE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACCUTANE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ACCUTANE 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACCUTANE 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACCUTANE 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACCUTANE 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ACEBUTOLOL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACEBUTOLOL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | S |
ACEBUTOLOL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACEBUTOLOL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | S |
ACEON 2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACEON 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ACEON 4MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACEON 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ACEON 8MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACEON 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACETADOTE 200MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ACETADOTE 200MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-15MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-15MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT).](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 |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAMINOPHEN/COD SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover ACETAMINOPHEN/COD SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETASOL HC SOLUTION 10ML 10 ML BOT ![Compare how all Medicare Part D PDP plans in UT cover ACETASOL HC SOLUTION 10ML 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETAZOLAMIDE 125MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACETAZOLAMIDE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAZOLAMIDE 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACETAZOLAMIDE 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETAZOLAMIDE SOD 500MG VL ![Compare how all Medicare Part D PDP plans in UT cover ACETAZOLAMIDE SOD 500MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETIC ACID 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in UT cover ACETIC ACID 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETIC ACID-HYDROCORTISONE 2%-1% DROPS ![Compare how all Medicare Part D PDP plans in UT cover ACETIC ACID-HYDROCORTISONE 2%-1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACETYLCYSTEINE 10% VIAL ![Compare how all Medicare Part D PDP plans in UT cover ACETYLCYSTEINE 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN ![Compare how all Medicare Part D PDP plans in UT cover ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACIPHEX 20MG TABLET EC ![Compare how all Medicare Part D PDP plans in UT cover ACIPHEX 20MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ACLOVATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ACLOVATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACLOVATE ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT(GM) TOPICAL ![Compare how all Medicare Part D PDP plans in UT cover ACLOVATE ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT(GM) TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACTHIB VACCINE VIAL 10-24UNT/5ML ![Compare how all Medicare Part D PDP plans in UT cover ACTHIB VACCINE VIAL 10-24UNT/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTICIN 5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ACTICIN 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACTIGALL 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ACTIGALL 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACTIMMUNE SOLUTION FOR INJECTION 100MCG ![Compare how all Medicare Part D PDP plans in UT cover ACTIMMUNE SOLUTION FOR INJECTION 100MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ACTIQ 1200MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 1200MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
ACTIQ 1600MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 1600MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
ACTIQ 200MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 200MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
ACTIQ 400MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 400MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTIQ 600MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 600MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
ACTIQ 800MCG LOZENGE ![Compare how all Medicare Part D PDP plans in UT cover ACTIQ 800MCG LOZENGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:4 /1Days |
ACTIVELLA 0.5-0.1MG TABLET 28 DLPK ![Compare how all Medicare Part D PDP plans in UT cover ACTIVELLA 0.5-0.1MG TABLET 28 DLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACTIVELLA 1-0.5MG TABLET 28 DLPK ![Compare how all Medicare Part D PDP plans in UT cover ACTIVELLA 1-0.5MG TABLET 28 DLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ACTONEL 150MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:1 /28Days |
ACTONEL 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTONEL 35MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL 35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:4 /28Days |
ACTONEL 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTONEL 75MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:2 /28Days |
ACTONEL WITH CALCIUM TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTONEL WITH CALCIUM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:1 /1Days |
ACTOPLUS MET 15MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTOPLUS MET 15MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTOPLUS MET 15MG/850MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTOPLUS MET 15MG/850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTOS 15MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTOS 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTOS 30MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACTOS 30MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACTOS 45MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ACTOS 45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACULAR 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ACULAR 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACULAR LS 0.4% OPHTH SOL ![Compare how all Medicare Part D PDP plans in UT cover ACULAR LS 0.4% OPHTH SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACULAR PF 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ACULAR PF 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ACYCLOVIR 200MG CAPSULE (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR 200MG CAPSULE (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACYCLOVIR 200MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR 200MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ACYCLOVIR 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACYCLOVIR SOD 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR SOD 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACYCLOVIR SODIUM 1GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR SODIUM 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACYCLOVIR SODIUM 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR SODIUM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ACYCLOVIR TABLET USP 800MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ACYCLOVIR TABLET USP 800MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in UT cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADAGEN 250U/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ADAGEN 250U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ADALAT CC 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADALAT CC 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ADALAT CC 60MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADALAT CC 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ADALAT CC 90MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADALAT CC 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ADDERALL 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL 15MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADDERALL 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:3 /1Days |
ADDERALL 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 10MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 10MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 15MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 15MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 20MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 20MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 25MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 25MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 30MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 30MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADDERALL XR 5MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover ADDERALL XR 5MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P S Q:2 /1Days |
ADOXA 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADOXA 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADOXA 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADOXA 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADOXA 75MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADOXA 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADOXA PAK 100MG TABLET DSPK-31 ![Compare how all Medicare Part D PDP plans in UT cover ADOXA PAK 100MG TABLET DSPK-31.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADOXA PAK 100MG TABLET DSPK-60 ![Compare how all Medicare Part D PDP plans in UT cover ADOXA PAK 100MG TABLET DSPK-60.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADOXA PAK 150MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADOXA PAK 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADOXA PAK 75MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADOXA PAK 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ADRIAMYCIN 10MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ADRIAMYCIN 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ADRIAMYCIN 20MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ADRIAMYCIN 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ADRIAMYCIN 50MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ADRIAMYCIN 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ADVAIR DISKU MIS 100/50 ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR DISKU MIS 100/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADVAIR DISKU MIS 250/50 ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR DISKU MIS 250/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADVAIR DISKU MIS 500/50 ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR DISKU MIS 500/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADVAIR HFA 115/21MCG INHALER ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA 115/21MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADVAIR HFA 230/21MCG INHALER ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA 230/21MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADVAIR HFA 45/21MCG INHALER ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA 45/21MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ADVICOR 1000-20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADVICOR 1000-20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ADVICOR 1000MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADVICOR 1000MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ADVICOR 500-20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ADVICOR 500-20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ADVICOR ER 20-750MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover ADVICOR ER 20-750MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
AEROBID AEROSOL W/ADAPTER ![Compare how all Medicare Part D PDP plans in UT cover AEROBID AEROSOL W/ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AEROBID-M AEROSOL W/ADAPTER ![Compare how all Medicare Part D PDP plans in UT cover AEROBID-M AEROSOL W/ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AFEDITAB CR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in UT cover AFEDITAB CR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFEDITAB CR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in UT cover AFEDITAB CR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | Q:2 /1Days |
AFINITOR TABLETS ![Compare how all Medicare Part D PDP plans in UT cover AFINITOR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:2 /1Days |
AFINITOR TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in UT cover AFINITOR TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P Q:3 /1Days |
AGGRENOX 25-200MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AGGRENOX 25-200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AGRYLIN 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AGRYLIN 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AK-CON 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover AK-CON 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AK-POLY-BAC EYE OINTMENT 500UNT/1000UNT ![Compare how all Medicare Part D PDP plans in UT cover AK-POLY-BAC EYE OINTMENT 500UNT/1000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AK-SPORE EYE OINTMENT 3.5 MG ![Compare how all Medicare Part D PDP plans in UT cover AK-SPORE EYE OINTMENT 3.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AKNE-MYCIN 2% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover AKNE-MYCIN 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AKTOB 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover AKTOB 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALA-CORT 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ALA-CORT 1% CREAM.](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 |
ALA-CORT 1% LOTION ![Compare how all Medicare Part D PDP plans in UT cover ALA-CORT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALA-SCALP HP 2% LOTION ![Compare how all Medicare Part D PDP plans in UT cover ALA-SCALP HP 2% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALAMAST 0.1% DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALAMAST 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALBALON LIQUIFILM 0.1% DROP ![Compare how all Medicare Part D PDP plans in UT cover ALBALON LIQUIFILM 0.1% DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALBENZA 200MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALBENZA 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
ALBUTEROL SULFATE 2.5MG/3ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE 2.5MG/3ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
ALBUTEROL SULFATE 4MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE 4MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ALBUTEROL SULFATE 8MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE 8MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ALBUTEROL SULFATE TABLET 2MG (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL SULFATE TABLET 2MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALBUTEROL TABLET 4MG (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALBUTEROL TABLET 4MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALCAINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALCAINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ALCLOMETASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ALCOHOL 5%/DEXTROSE 5% ![Compare how all Medicare Part D PDP plans in UT cover ALCOHOL 5%/DEXTROSE 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALCOHOL ANTISEPTIC PADS ![Compare how all Medicare Part D PDP plans in UT cover ALCOHOL ANTISEPTIC PADS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALDACTAZIDE 25/25 TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALDACTAZIDE 25/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALDACTAZIDE 50/50 TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALDACTAZIDE 50/50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALDACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALDACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALDACTONE 25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALDACTONE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALDACTONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALDACTONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALDARA 5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ALDARA 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALDURAZYME 2.9MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALDURAZYME 2.9MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ALENDRONATE SODIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALENDRONATE SODIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALENDRONATE SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALENDRONATE SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALENDRONATE SODIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALENDRONATE SODIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALENDRONATE SODIUM 70MG TABLET 4 BLPK ![Compare how all Medicare Part D PDP plans in UT cover ALENDRONATE SODIUM 70MG TABLET 4 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | Q:4 /28Days |
ALENDRONATE SODIUM TABLET 35MG 20 CRTN ![Compare how all Medicare Part D PDP plans in UT cover ALENDRONATE SODIUM TABLET 35MG 20 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | Q:4 /28Days |
ALFERON N INJ 5MU/ML ![Compare how all Medicare Part D PDP plans in UT cover ALFERON N INJ 5MU/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ALIMTA 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALIMTA 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALIMTA INJECTION ![Compare how all Medicare Part D PDP plans in UT cover ALIMTA INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ALINIA 100MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover ALINIA 100MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALINIA 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALINIA 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALKERAN 50MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALKERAN 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | P |
ALLEGRA 180MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA 180MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:1 /1Days |
ALLEGRA 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:2 /1Days |
ALLEGRA 30MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA 30MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:10 /1Days |
ALLEGRA 60MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:2 /1Days |
ALLEGRA-D 12 HOUR TABLET 60-120MG (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA-D 12 HOUR TABLET 60-120MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALLEGRA-D 24 HOUR TABLET ![Compare how all Medicare Part D PDP plans in UT cover ALLEGRA-D 24 HOUR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:1 /1Days |
ALLOPURINOL SODIUM 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALLOPURINOL SODIUM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALLOPURINOL TABLET 300MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALLOPURINOL TABLET 300MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALLOPURINOL TABLET USP 100MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALLOPURINOL TABLET USP 100MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ALOCRIL 2% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALOCRIL 2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALOMIDE 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALOMIDE 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALOPRIM 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALOPRIM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALORA 0.025MG PATCH ![Compare how all Medicare Part D PDP plans in UT cover ALORA 0.025MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /28Days |
ALORA 0.05MG PATCH ![Compare how all Medicare Part D PDP plans in UT cover ALORA 0.05MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /28Days |
ALORA 0.075MG PATCH ![Compare how all Medicare Part D PDP plans in UT cover ALORA 0.075MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /28Days |
ALORA 0.1MG PATCH ![Compare how all Medicare Part D PDP plans in UT cover ALORA 0.1MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /28Days |
ALOXI 0.25MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ALOXI 0.25MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ALPHAGAN P 0.1% DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALPHAGAN P 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALPHAGAN P 0.15% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALPHAGAN P 0.15% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ALREX 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ALREX 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ALTABAX 1% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover ALTABAX 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALTACE 1.25MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ALTACE 1.25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALTACE 10MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ALTACE 10MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALTACE 2.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ALTACE 2.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALTACE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ALTACE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALTACE TABLETS 1.25MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover ALTACE TABLETS 1.25MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALTACE TABLETS 10MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover ALTACE TABLETS 10MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALTACE TABLETS 2.5MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover ALTACE TABLETS 2.5MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ALTACE TABLETS 5MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover ALTACE TABLETS 5MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALTOPREV 20MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in UT cover ALTOPREV 20MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ALTOPREV 40MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in UT cover ALTOPREV 40MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ALTOPREV 60MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in UT cover ALTOPREV 60MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
ALUPENT 650MCG INHALER COMP ![Compare how all Medicare Part D PDP plans in UT cover ALUPENT 650MCG INHALER COMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALVESCO 160MCG/ACT AERS ![Compare how all Medicare Part D PDP plans in UT cover ALVESCO 160MCG/ACT AERS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ALVESCO 80MCG/ACT AERS ![Compare how all Medicare Part D PDP plans in UT cover ALVESCO 80MCG/ACT AERS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMANTADINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMANTADINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMANTADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMANTADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMARYL 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMARYL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMARYL 2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMARYL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMARYL 4MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMARYL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMBIEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMBIEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AMBIEN 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMBIEN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
AMBIEN CR 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMBIEN CR 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | S Q:1 /1Days |
AMBIEN CR 6.25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMBIEN CR 6.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | S Q:1 /1Days |
AMBISOME 50MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMBISOME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMCINONIDE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover AMCINONIDE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMCINONIDE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in UT cover AMCINONIDE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMCINONIDE 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in UT cover AMCINONIDE 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMERGE 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMERGE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:9 /30Days |
AMERGE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMERGE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | Q:9 /30Days |
AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM ![Compare how all Medicare Part D PDP plans in UT cover AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMIFOSTINE FOR INJECTION 500MG/VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMIFOSTINE FOR INJECTION 500MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AMIKACIN 250MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMIKACIN 250MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMIKACIN 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMIKACIN 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMIKIN 250MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMIKIN 250MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMIKIN POWDER FOR INJECTION ![Compare how all Medicare Part D PDP plans in UT cover AMIKIN POWDER FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMILORIDE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMILORIDE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMILORIDE HCL W/HCTZ 5MG-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMINESS 5.2% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINESS 5.2% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOPHYLLINE 100MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMINOPHYLLINE 100MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMINOPHYLLINE 200MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMINOPHYLLINE 200MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD ![Compare how all Medicare Part D PDP plans in UT cover AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD.](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 |
AMINOSYN 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN 5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN 7%-ELECTROLYTE SOL ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 7%-ELECTROLYTE SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 3.5% IN D25W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 3.5% IN D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 3.5% IN D5W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 3.5% IN D5W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 3.5% M/D5W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 3.5% M/D5W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN II 3.5% W/ELEC DEX ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 3.5% W/ELEC DEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 4.25% IN D10W ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 4.25% IN D10W.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 4.25% IN D20W ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 4.25% IN D20W.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 4.25% M/D10W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 4.25% M/D10W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 4.25% W/ELEC DW ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 4.25% W/ELEC DW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 4.25%-D25W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 4.25%-D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 5% IN D25W IV ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 5% IN D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 8.5% ELECTROLYT ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 8.5% ELECTROLYT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN II 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN II 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN M 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN M 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN PF INJECTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN PF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5% ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN-HBC 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN-HBC 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN-HF 8% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN-HF 8% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMINOSYN-PF 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AMINOSYN-PF 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMIODARONE HCL 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMIODARONE HCL 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMIODARONE HCL 400MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMIODARONE HCL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMIODARONE HCL INJECTION ![Compare how all Medicare Part D PDP plans in UT cover AMIODARONE HCL INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITIZA 24 MCG CAPSULES ![Compare how all Medicare Part D PDP plans in UT cover AMITIZA 24 MCG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMITIZA 8MCG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMITIZA 8MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
AMITRIP/CDP 25-10 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/CDP 25-10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIP/PERPHEN 10-2 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/PERPHEN 10-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIP/PERPHEN 10-4 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/PERPHEN 10-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIP/PERPHEN 25-2 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/PERPHEN 25-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIP/PERPHEN 25-4 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/PERPHEN 25-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIP/PERPHEN 50-4 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIP/PERPHEN 50-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 25MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL 75MG TABLET USP (100 CT).](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 |
AMLODIPINE BESYLATE 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | S |
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE 2.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | S Q:1 /1Days |
AMLODIPINE BESYLATE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | S Q:1 /1Days |
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMMONIUM CHLORIDE 5 MEQ/ML ![Compare how all Medicare Part D PDP plans in UT cover AMMONIUM CHLORIDE 5 MEQ/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMMONIUM LACTATE 12% CREAM ![Compare how all Medicare Part D PDP plans in UT cover AMMONIUM LACTATE 12% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in UT cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in UT cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMNESTEEM 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMNESTEEM 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
AMNESTEEM 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMNESTEEM 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
AMNESTEEM 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMNESTEEM 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
AMOCLAN 200-28.5/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AMOCLAN 200-28.5/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOCLAN 400-57MG/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AMOCLAN 400-57MG/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-K CLV 200-28.5 CHEW ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-K CLV 200-28.5 CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-K CLV 200-28.5/5 SU ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-K CLV 200-28.5/5 SU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-K CLV 400-57 CHW TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-K CLV 400-57 CHW TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-K CLV 400-57/5 SUSP ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-K CLV 400-57/5 SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-K CLV 500-125MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-K CLV 500-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 500-125MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOX TR-POTASSIUM CLAVULANATE 500-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOXAPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICIILIN CLAVULNATE POTASSIUM FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AMOXICIILIN CLAVULNATE POTASSIUM FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICILLIN 125MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 125MG TABLET CHEW.](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 |
AMOXICILLIN 200MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 200MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 400MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 400MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICILLIN 875MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN 875MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM TABLET 875-125MG 1 BLPK ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN CLAVULANATE POTASSIUM TABLET 875-125MG 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](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 |
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT) ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMOXIL 250MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AMOXIL 250MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMOXIL 400MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AMOXIL 400MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMOXIL 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMOXIL 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMOXIL 50MG/ML PED DROPS ![Compare how all Medicare Part D PDP plans in UT cover AMOXIL 50MG/ML PED DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AMPHET ASP/ AMPHET/ D-AMPHET 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHET ASP/ AMPHET/ D-AMPHET 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHET ASP/ AMPHET/ D-AMPHET 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHET ASP/ AMPHET/ D-AMPHET 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHETAMINE SALT COMBO 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALT COMBO 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHETAMINE SALT COMBO 15MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALT COMBO 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHETAMINE SALT COMBO 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALT COMBO 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPHETAMINE SALT COMBO 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALT COMBO 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHETAMINE SALTS 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALTS 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:3 /1Days |
AMPHETAMINE SALTS 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMPHETAMINE SALTS 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P Q:2 /1Days |
AMPHOTEC 100MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPHOTEC 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AMPHOTEC INJ 50MG ![Compare how all Medicare Part D PDP plans in UT cover AMPHOTEC INJ 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AMPHOTERICIN B FOR INJECTION 50 MG ![Compare how all Medicare Part D PDP plans in UT cover AMPHOTERICIN B FOR INJECTION 50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN AND SULBACTAM FOR INJECTION 1-0.5 10 VIAL VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN AND SULBACTAM FOR INJECTION 1-0.5 10 VIAL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN FOR INJECTION 1GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN FOR INJECTION 2GM/ML 10 VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION 2GM/ML 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN FOR INJECTION 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN FOR INJECTION POWDER ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN POWDER FOR INJECTION 1 GM/ML ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN POWDER FOR INJECTION 1 GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN SODIUM STERILE 2 GM/VIAL ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN SODIUM STERILE 2 GM/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AMPICILLIN TR 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN TR 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMPICILLIN TR 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN TR 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
AMRIX 15MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AMRIX 15MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMRIX 30MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AMRIX 30MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ANADROL-50 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ANADROL-50 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ANAFRANIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANAFRANIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANAFRANIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANAFRANIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANAFRANIL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANAFRANIL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANAGRELIDE HCL 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANAGRELIDE HCL 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ANAGRELIDE HCL 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANAGRELIDE HCL 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ANAPROX 275MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANAPROX 275MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANAPROX DS 550MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANAPROX DS 550MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANCOBON 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANCOBON 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANCOBON 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANCOBON 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANDRODERM 2.5MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover ANDRODERM 2.5MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANDRODERM 5MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover ANDRODERM 5MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANDROGEL 1%(25MG) GEL PACKET ![Compare how all Medicare Part D PDP plans in UT cover ANDROGEL 1%(25MG) GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANDROGEL 1.25G (1%) GEL IN METERED-DOSE PUMP ![Compare how all Medicare Part D PDP plans in UT cover ANDROGEL 1.25G (1%) GEL IN METERED-DOSE PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANDROGEL 1%(50MG) GEL PACKET ![Compare how all Medicare Part D PDP plans in UT cover ANDROGEL 1%(50MG) GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANDROID 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANDROID 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ANGELIQ 1-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANGELIQ 1-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANTABUSE 250MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANTABUSE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:2 /1Days |
ANTABUSE 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANTABUSE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:1 /1Days |
ANTARA 130MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANTARA 130MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ANTARA 43MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ANTARA 43MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANTIVERT 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANTIVERT 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANTIVERT 25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANTIVERT 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANTIVERT 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANTIVERT 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANTIZOL INJECTION 1GM 4 X 1.5ML VIAL CRTN ![Compare how all Medicare Part D PDP plans in UT cover ANTIZOL INJECTION 1GM 4 X 1.5ML VIAL CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANUSOL-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover ANUSOL-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ANZEMET 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANZEMET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:5 /30Days |
ANZEMET 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ANZEMET 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
ANZEMET 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ANZEMET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P Q:5 /30Days |
APHTHASOL 5% PASTE ![Compare how all Medicare Part D PDP plans in UT cover APHTHASOL 5% PASTE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
APIDRA 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover APIDRA 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
APLENZIN TABLETS EXTENDED RELEASE 348 MG ![Compare how all Medicare Part D PDP plans in UT cover APLENZIN TABLETS EXTENDED RELEASE 348 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
APLENZIN TABLETS EXTENDED RELEASE 522 MG ![Compare how all Medicare Part D PDP plans in UT cover APLENZIN TABLETS EXTENDED RELEASE 522 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
APOKYN FOR INJECTION 30MG 5 CTG ![Compare how all Medicare Part D PDP plans in UT cover APOKYN FOR INJECTION 30MG 5 CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in UT cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
APRISO CP24 ![Compare how all Medicare Part D PDP plans in UT cover APRISO CP24.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:4 /1Days |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARALAST 1000MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARALAST 1000MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARALAST 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARALAST 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARALEN PHOSPHATE 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARALEN PHOSPHATE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ARANESP 100MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 100MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP 200MCG/0.4ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 200MCG/0.4ML SYRINGE.](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 |
ARANESP 200MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 200MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP 25MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 25MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | P |
ARANESP 300MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 300MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP 500MCG/1ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 500MCG/1ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP 60MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARANESP 60MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP SINGLE USE PREFILLED AUTOINJECTOR SOLUTION 100MCG/.5ML ![Compare how all Medicare Part D PDP plans in UT cover ARANESP SINGLE USE PREFILLED AUTOINJECTOR SOLUTION 100MCG/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP SINGLE USE PREFILLED SURECLICK AUTOINJECTOR SOLUTION 500MCG/ML ![Compare how all Medicare Part D PDP plans in UT cover ARANESP SINGLE USE PREFILLED SURECLICK AUTOINJECTOR SOLUTION 500MCG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP SINGLE USE PREFILLED SURECLIK AUTOINJECTOR 60MCG/.3ML ![Compare how all Medicare Part D PDP plans in UT cover ARANESP SINGLE USE PREFILLED SURECLIK AUTOINJECTOR 60MCG/.3ML.](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 |
ARANESP SINGLE USE VIAL 150MCG 4 X 150MCG/ 0.75ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover ARANESP SINGLE USE VIAL 150MCG 4 X 150MCG/ 0.75ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
ARAVA 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARAVA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ARAVA 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARAVA 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ARCALYST INJECTION 220MG/VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARCALYST INJECTION 220MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AREDIA 30MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AREDIA 30MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AREDIA 90MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AREDIA 90MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARICEPT 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARICEPT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ARICEPT 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARICEPT 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ARICEPT ODT 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARICEPT ODT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ARICEPT ODT 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARICEPT ODT 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARIMIDEX 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ARIMIDEX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ARIXTRA 10MG SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARIXTRA 10MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARIXTRA 2.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARIXTRA 2.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARIXTRA 5MG SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARIXTRA 5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARIXTRA 7.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ARIXTRA 7.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AROMASIN 25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AROMASIN 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ARRANON 250MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover ARRANON 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ARTHROTEC 50 50MG TABLET -200MCG (60 CT) ![Compare how all Medicare Part D PDP plans in UT cover ARTHROTEC 50 50MG TABLET -200MCG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ARTHROTEC 75 TABLET EC ![Compare how all Medicare Part D PDP plans in UT cover ARTHROTEC 75 TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ASACOL 400MG TABLET EC ![Compare how all Medicare Part D PDP plans in UT cover ASACOL 400MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:12 /1Days |
ASCOMP W/CODEINE 30-50-325 CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover ASCOMP W/CODEINE 30-50-325 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in UT cover ASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ASMANEX TWISTHALER 220MCG #120 ![Compare how all Medicare Part D PDP plans in UT cover ASMANEX TWISTHALER 220MCG #120.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ASMANEX TWISTHALER 220MCG #30 ![Compare how all Medicare Part D PDP plans in UT cover ASMANEX TWISTHALER 220MCG #30.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ASMANEX TWISTHALER 220MCG #60 ![Compare how all Medicare Part D PDP plans in UT cover ASMANEX TWISTHALER 220MCG #60.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
ASTELIN 137MCG AEROSOL SPRAY W/PUMP ![Compare how all Medicare Part D PDP plans in UT cover ASTELIN 137MCG AEROSOL SPRAY W/PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ASTEPRO NASAL SPRAY 137 MCG/SPRY ![Compare how all Medicare Part D PDP plans in UT cover ASTEPRO NASAL SPRAY 137 MCG/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ASTRAMORPH-PF 0.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ASTRAMORPH-PF 0.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ASTRAMORPH-PF 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover ASTRAMORPH-PF 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ATACAND 16MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND 16MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ATACAND 32MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND 32MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ATACAND 4MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATACAND 8MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ATACAND HCT 16/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND HCT 16/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:2 /1Days |
ATACAND HCT 32/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ATACAND HCT 32/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ATACAND HCT TABLETS 32;25MG;MG 90 TABLETS BOT ![Compare how all Medicare Part D PDP plans in UT cover ATACAND HCT TABLETS 32;25MG;MG 90 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
ATAMET ![Compare how all Medicare Part D PDP plans in UT cover ATAMET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
ATENOLOL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | S |
ATENOLOL TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | S |
ATENOLOL TABLET USP 50MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL TABLET USP 50MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | S |
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
ATGAM 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in UT cover ATGAM 50MG/ML AMPUL.](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 |
ATRALIN 0.05% GEL ![Compare how all Medicare Part D PDP plans in UT cover ATRALIN 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ATRIPLA TABLET 600MG/200MG ![Compare how all Medicare Part D PDP plans in UT cover ATRIPLA TABLET 600MG/200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
ATROPINE 0.05MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ATROPINE 0.05MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
ATROPINE 0.1MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover ATROPINE 0.1MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in UT cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ATROVENT NASAL SPRAY 0.03% ![Compare how all Medicare Part D PDP plans in UT cover ATROVENT NASAL SPRAY 0.03%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ATROVENT NASAL SPRAY 0.06% ![Compare how all Medicare Part D PDP plans in UT cover ATROVENT NASAL SPRAY 0.06%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in UT cover ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AUGMENTIN 125 SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 125 SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 200MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 200MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 250 SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 250 SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AUGMENTIN 250 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 250 TABLET CHEW ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 250 TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 400MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 400MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN 875MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN 875MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN ES-600 SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN ES-600 SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AUGMENTIN XR 1000-62.5 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN XR 1000-62.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVALIDE 150-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVALIDE 150-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AVALIDE 300-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVALIDE 300-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
AVALIDE 300-25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVALIDE 300-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
AVANDAMET 2MG/1000MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDAMET 2MG/1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVANDAMET 2MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDAMET 2MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDAMET 4MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDAMET 4MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDAMET TABLET 4-1000MG ![Compare how all Medicare Part D PDP plans in UT cover AVANDAMET TABLET 4-1000MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDARYL 4MG/1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDARYL 4MG/1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDARYL 4MG/2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDARYL 4MG/2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDARYL 4MG/4MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDARYL 4MG/4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDARYL 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDARYL 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDARYL 8MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDARYL 8MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDIA 2MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVANDIA 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDIA 4MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover AVANDIA 4MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVANDIA 8MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover AVANDIA 8MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVAPRO 150MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVAPRO 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AVAPRO 300MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVAPRO 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S |
AVAPRO 75MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AVAPRO 75MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AVASTIN 100MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover AVASTIN 100MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
AVASTIN 400MG/16ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover AVASTIN 400MG/16ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
AVELOX 400MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVELOX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVELOX ABC PACK 400MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVELOX ABC PACK 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVELOX IV 400MG/250ML ![Compare how all Medicare Part D PDP plans in UT cover AVELOX IV 400MG/250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in UT cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AVINZA 120MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AVINZA 120MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVINZA 30MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AVINZA 30MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVINZA 60MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AVINZA 60MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVINZA 90MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in UT cover AVINZA 90MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVINZA CAPSULES EXTENDED RELEASE 45MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover AVINZA CAPSULES EXTENDED RELEASE 45MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVINZA CAPSULES EXTENDED RELEASE 75MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in UT cover AVINZA CAPSULES EXTENDED RELEASE 75MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AVITA 0.025% CREAM ![Compare how all Medicare Part D PDP plans in UT cover AVITA 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AVODART 0.5MG SOFTGEL ![Compare how all Medicare Part D PDP plans in UT cover AVODART 0.5MG SOFTGEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | P |
AVONEX ADMIN PACK 30MCG SYR ![Compare how all Medicare Part D PDP plans in UT cover AVONEX ADMIN PACK 30MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AVONEX ADMIN PACK 30MCG VL ![Compare how all Medicare Part D PDP plans in UT cover AVONEX ADMIN PACK 30MCG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
AXERT 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AXERT 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /30Days |
AXERT 6.25MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AXERT 6.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:8 /30Days |
AXID 150MG PULVULE ![Compare how all Medicare Part D PDP plans in UT cover AXID 150MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AXID 15MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover AXID 15MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AXID NIZATIDINE CAPSULES 300MG (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AXID NIZATIDINE CAPSULES 300MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AYGESTIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AYGESTIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AZACTAM 1GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover AZACTAM 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZACTAM 2GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover AZACTAM 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZACTAM INJECTION 1GM 50ML BAG ![Compare how all Medicare Part D PDP plans in UT cover AZACTAM INJECTION 1GM 50ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZACTAM/ISO-OSMOT 2GM/50ML ![Compare how all Medicare Part D PDP plans in UT cover AZACTAM/ISO-OSMOT 2GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZASAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZASAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
AZASAN 75MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZASAN 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | P |
AZASITE 1% DROPS ![Compare how all Medicare Part D PDP plans in UT cover AZASITE 1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AZATHIOPRINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZATHIOPRINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZATHIOPRINE SOD 100MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover AZATHIOPRINE SOD 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | P |
AZELEX 20% CREAM 30GM TUBE ![Compare how all Medicare Part D PDP plans in UT cover AZELEX 20% CREAM 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AZILECT 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZILECT 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZILECT 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZILECT 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN 1G PACKET ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN 1G PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN 250MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN 250MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN 500MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN 500MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
AZITHROMYCIN TABLET 600MG (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AZITHROMYCIN TABLET 600MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$5.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZMACORT AER 75MCG ![Compare how all Medicare Part D PDP plans in UT cover AZMACORT AER 75MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | None |
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in UT cover AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$35.00 | $80.00 | None |
AZOR 10MG-20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZOR 10MG-20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AZOR 10MG-40MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AZOR 10MG-40MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AZOR 5MG-20MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover AZOR 5MG-20MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AZOR 5MG-40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZOR 5MG-40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | S Q:1 /1Days |
AZULFIDINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AZULFIDINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:12 /1Days |
AZULFIDINE EN TABLET S 500MG TABLET 6 X (300 CT)PL ![Compare how all Medicare Part D PDP plans in UT cover AZULFIDINE EN TABLET S 500MG TABLET 6 X (300 CT)PL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$90.00 | $180.00 | Q:12 /1Days |