2010 Medicare Part D Plan Formulary Information |
Humana Gold Choice H2944-057 (PFFS) (H2944-057-0)
Benefit Details
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The Humana Gold Choice H2944-057 (PFFS) (H2944-057-0) Formulary Drugs Starting with the Letter F in Statewide County, UT: CMS MA Region 23 which includes: UT
|
Drugs Starting with Letter F
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
FABRAZYME 35MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover FABRAZYME 35MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
FACTIVE 320MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FACTIVE 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FAMCICLOVIR 125MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FAMCICLOVIR 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FAMCICLOVIR 250MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FAMCICLOVIR 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FAMCICLOVIR 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FAMCICLOVIR 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FAMOTIDINE 20MG PIGGYBACK ![Compare how all Medicare Part D PDP plans in UT cover FAMOTIDINE 20MG PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FAMOTIDINE 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover FAMOTIDINE 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FAMOTIDINE 40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FAMOTIDINE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FAMOTIDINE INJECTION 10MG 25 X 2ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover FAMOTIDINE INJECTION 10MG 25 X 2ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FANSIDAR 500/25 TABLET ![Compare how all Medicare Part D PDP plans in UT cover FANSIDAR 500/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FARESTON 60MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FARESTON 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days |
FASLODEX 125MG/2.5ML SYRNGE ![Compare how all Medicare Part D PDP plans in UT cover FASLODEX 125MG/2.5ML SYRNGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:2 /30Days |
FASLODEX 250MG/5ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover FASLODEX 250MG/5ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:5 /30Days |
FAZACLO 12.5MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in UT cover FAZACLO 12.5MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | S |
FAZACLO TABLET ORALLY DISINTEGRATING 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FAZACLO TABLET ORALLY DISINTEGRATING 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | S |
FAZACLO TABLET ORALLY DISINTEGRATING 25MG (10 CT) ![Compare how all Medicare Part D PDP plans in UT cover FAZACLO TABLET ORALLY DISINTEGRATING 25MG (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | S |
FELBATOL 400MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FELBATOL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FELBATOL 600MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FELBATOL 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FELBATOL 600MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in UT cover FELBATOL 600MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FELODIPINE ER 2.5MG TABLET 90 TABLET BOT ![Compare how all Medicare Part D PDP plans in UT cover FELODIPINE ER 2.5MG TABLET 90 TABLET BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days |
FELODIPINE TABLET ER 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover FELODIPINE TABLET ER 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FELODIPINE TABLET ER 5MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover FELODIPINE TABLET ER 5MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days |
FEMARA 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMARA 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:30 /30Days |
FEMHRT 0.5MG/2.5MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMHRT 0.5MG/2.5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FEMHRT 1/5 TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMHRT 1/5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FEMRING 0.05MG VAGINAL RING ![Compare how all Medicare Part D PDP plans in UT cover FEMRING 0.05MG VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days |
FEMRING 0.10MG VAGINAL RING ![Compare how all Medicare Part D PDP plans in UT cover FEMRING 0.10MG VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /90Days |
FEMTRACE 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMTRACE 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FEMTRACE 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMTRACE 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FEMTRACE 1.8MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEMTRACE 1.8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FENOFIBRATE 134MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover FENOFIBRATE 134MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
FENOFIBRATE 160MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FENOFIBRATE 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENOFIBRATE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover FENOFIBRATE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
FENOFIBRATE 54MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FENOFIBRATE 54MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
FENOFIBRATE 67MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover FENOFIBRATE 67MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
FENOPROFEN 600MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FENOPROFEN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:20 /30Days |
FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:20 /30Days |
FENTANYL CITRATE INJECTION 50MCG 10 X 2ML CTG ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL CITRATE INJECTION 50MCG 10 X 2ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:20 /30Days |
FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:20 /30Days |
FENTANYL TRANSDERMAL SYSTEM 75MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in UT cover FENTANYL TRANSDERMAL SYSTEM 75MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:20 /30Days |
FEXOFENADINE HCL 180MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEXOFENADINE HCL 180MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FEXOFENADINE HCL 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FEXOFENADINE HCL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
FEXOFENADINE HCL 60MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FEXOFENADINE HCL 60MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
FINACEA 15% GEL ![Compare how all Medicare Part D PDP plans in UT cover FINACEA 15% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FINASTERIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FINASTERIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
FLAREX 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover FLAREX 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FLAVOXATE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLAVOXATE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLEBOGAMMA INJECTION 50MG ![Compare how all Medicare Part D PDP plans in UT cover FLEBOGAMMA INJECTION 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
FLECAINIDE ACETATE 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLECAINIDE ACETATE 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLECAINIDE ACETATE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLECAINIDE ACETATE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLECAINIDE ACETATE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLECAINIDE ACETATE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLOMAX 0.4MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover FLOMAX 0.4MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLONASE 0.05% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover FLONASE 0.05% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:16 /30Days |
FLOVENT DISKUS /BLIST AEPB ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT DISKUS /BLIST AEPB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days |
FLOVENT DISKUS /BLIST AEPB ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT DISKUS /BLIST AEPB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days |
FLOVENT DISKUS POWDER 50MCG 60 CTR ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT DISKUS POWDER 50MCG 60 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:60 /30Days |
FLOVENT HFA 110MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT HFA 110MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:24 /30Days |
FLOVENT HFA 220MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT HFA 220MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:24 /30Days |
FLOVENT HFA 44MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in UT cover FLOVENT HFA 44MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:1 /30Days |
FLUCONAZOLE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUCONAZOLE 10MG/ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 10MG/ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUCONAZOLE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:4 /28Days |
FLUCONAZOLE 200MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 200MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUCONAZOLE 40MG/ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 40MG/ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUCONAZOLE 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUCONAZOLE INJECTION 200MG 6 X 200/250ML CTR ![Compare how all Medicare Part D PDP plans in UT cover FLUCONAZOLE INJECTION 200MG 6 X 200/250ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUDARA 50MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover FLUDARA 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
FLUDARABINE 50MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover FLUDARABINE 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUDARABINE 50MG/2ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover FLUDARABINE 50MG/2ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUMADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUMADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL ![Compare how all Medicare Part D PDP plans in UT cover FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:50 /30Days |
FLUOCINOLONE 0.01% CREAM ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINOLONE 0.01% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINOLONE 0.01% SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINOLONE 0.01% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUOCINOLONE 0.025% CREAM ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINOLONE 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINOLONE 0.025% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINOLONE 0.025% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINONIDE 0.05% GEL ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINONIDE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINONIDE 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINONIDE 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOCINONIDE EMOLLIENT 0.05% CREAM ![Compare how all Medicare Part D PDP plans in UT cover FLUOCINONIDE EMOLLIENT 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOR-OP 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover FLUOR-OP 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOROMETHOLONE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in UT cover FLUOROMETHOLONE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOROPLEX 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover FLUOROPLEX 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FLUOROURACIL 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in UT cover FLUOROURACIL 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLUOROURACIL 5% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in UT cover FLUOROURACIL 5% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUOROURACIL CREA 5% ![Compare how all Medicare Part D PDP plans in UT cover FLUOROURACIL CREA 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLUOROURACIL INJECTION 50MG/ML 10 X 10 ML VIALGL ![Compare how all Medicare Part D PDP plans in UT cover FLUOROURACIL INJECTION 50MG/ML 10 X 10 ML VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLUOXETINE 20MG CAPSULES (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE 20MG CAPSULES (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:120 /30Days |
FLUOXETINE 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUOXETINE 40MG CAPSULE (30 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE 40MG CAPSULE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
FLUOXETINE CAPSULES 10MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE CAPSULES 10MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
FLUOXETINE HCL 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE HCL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:120 /30Days |
FLUOXETINE HYDROCHLORIDE TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover FLUOXETINE HYDROCHLORIDE TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
FLUOXYMESTERONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUOXYMESTERONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FLUPHENAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUPHENAZINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE 2.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 2.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE 5MG/ML CONC ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE 5MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE DECANOATE INJECTION USP 25MG 1 X 5ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE DECANOATE INJECTION USP 25MG 1 X 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUPHENAZINE HCL 2.5MG/5ML ELIXIR ![Compare how all Medicare Part D PDP plans in UT cover FLUPHENAZINE HCL 2.5MG/5ML ELIXIR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLURBIPROFEN 0.03% EYE DROP ![Compare how all Medicare Part D PDP plans in UT cover FLURBIPROFEN 0.03% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLURBIPROFEN 100MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLURBIPROFEN 100MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLURBIPROFEN 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLURBIPROFEN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUTAMIDE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover FLUTAMIDE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | None |
FLUTICASONE PROPIONATE 0.005% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover FLUTICASONE PROPIONATE 0.005% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUTICASONE PROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in UT cover FLUTICASONE PROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | Q:16 /30Days |
FLUVOXAMINE MALEATE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUVOXAMINE MALEATE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:90 /30Days |
FLUVOXAMINE MALEATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FLUVOXAMINE MALEATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:90 /30Days |
FLUVOXAMINE MALEATE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FLUVOXAMINE MALEATE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:90 /30Days |
FML FORTE 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover FML FORTE 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FML LIQUIFILM 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in UT cover FML LIQUIFILM 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FML S.O.P. 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover FML S.O.P. 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FOMEPIZOLE INJECTION 1GM/ML ![Compare how all Medicare Part D PDP plans in UT cover FOMEPIZOLE INJECTION 1GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FORADIL AEROLIZER 12 MCG CAP ![Compare how all Medicare Part D PDP plans in UT cover FORADIL AEROLIZER 12 MCG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:60 /30Days |
FORTAZ 1GM ADD-VANTAGE VIAL ![Compare how all Medicare Part D PDP plans in UT cover FORTAZ 1GM ADD-VANTAGE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FORTAZ 2GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover FORTAZ 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FORTAZ 6GM VIAL ![Compare how all Medicare Part D PDP plans in UT cover FORTAZ 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FORTAZ/ISO-OSMOT 2GM/50ML ![Compare how all Medicare Part D PDP plans in UT cover FORTAZ/ISO-OSMOT 2GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FORTAZ/ISO-OSMOTIC 1GM/50ML ![Compare how all Medicare Part D PDP plans in UT cover FORTAZ/ISO-OSMOTIC 1GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FORTEO INJECTION ![Compare how all Medicare Part D PDP plans in UT cover FORTEO INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
FORTICAL 200 U/DOSE AEROSOL SPRAY W/PUMP ![Compare how all Medicare Part D PDP plans in UT cover FORTICAL 200 U/DOSE AEROSOL SPRAY W/PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$42.00 | $105.00 | Q:4 /28Days |
FOSCARNET 24MG/ML INFUS BTTL ![Compare how all Medicare Part D PDP plans in UT cover FOSCARNET 24MG/ML INFUS BTTL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | P |
FOSCAVIR 24MG/ML INFUS BTTL ![Compare how all Medicare Part D PDP plans in UT cover FOSCAVIR 24MG/ML INFUS BTTL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
FOSINOPRIL SODIUM 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in UT cover FOSINOPRIL SODIUM 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FOSINOPRIL SODIUM 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FOSINOPRIL SODIUM 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FOSINOPRIL SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FOSINOPRIL SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FOSPHEN SDV 50MGPE/ML 2MLGEN10 50MG PE/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover FOSPHEN SDV 50MGPE/ML 2MLGEN10 50MG PE/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1 ![Compare how all Medicare Part D PDP plans in UT cover FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:1 /30Days |
FRAGMIN 2500UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in UT cover FRAGMIN 2500UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days |
FRAGMIN 5000UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in UT cover FRAGMIN 5000UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days |
FRAGMIN INJECTION 10000UNITS 1 X 10 SYR ![Compare how all Medicare Part D PDP plans in UT cover FRAGMIN INJECTION 10000UNITS 1 X 10 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:2 /30Days |
FRAGMIN INJECTION 7500UNT/ML ![Compare how all Medicare Part D PDP plans in UT cover FRAGMIN INJECTION 7500UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days |
FREAMINE HBC INJECTION ![Compare how all Medicare Part D PDP plans in UT cover FREAMINE HBC INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | P |
FREAMINE III INJECTION 8.5% ![Compare how all Medicare Part D PDP plans in UT cover FREAMINE III INJECTION 8.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | P |
FREAMINE III INJECTION WITH ELECTROLYTES 3% ![Compare how all Medicare Part D PDP plans in UT cover FREAMINE III INJECTION WITH ELECTROLYTES 3%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FUROSEMIDE 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUROSEMIDE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUROSEMIDE 40MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUROSEMIDE 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUROSEMIDE 80MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE 80MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUROSEMIDE INJECTION USP 10MG 25 X 4ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover FUROSEMIDE INJECTION USP 10MG 25 X 4ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $0.00 | None |
FUZEON CONVENIENCE KIT ![Compare how all Medicare Part D PDP plans in UT cover FUZEON CONVENIENCE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:60 /30Days |