2010 Medicare Part D Plan Formulary Information |
Molina Medicare Options (HMO) (H5628-002-0)
Benefit Details
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The Molina Medicare Options (HMO) (H5628-002-0) Formulary Drugs Starting with the Letter A in Weber County, UT: CMS MA Region 23 which includes: 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 |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | P S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | None |
ACETASOL HC OTIC SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover ACETASOL HC OTIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | Q:2 /30Days |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | Q:60 /30Days |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | Q:60 /30Days |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | Q:60 /30Days |
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADVAIR HFA INHALER 230;21MCG;MCG ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA INHALER 230;21MCG;MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in UT cover ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:6 /30Days |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:40 /30Days |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
ALDARA IMIQUIMOD CREAM 5% 24 PKT X 250 MG CRTN ![Compare how all Medicare Part D PDP plans in UT cover ALDARA IMIQUIMOD CREAM 5% 24 PKT X 250 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
4 |
Tier 4 |
33% | 33% | P |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | None |
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) |
4 |
Tier 4 |
33% | 33% | P |
ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU ![Compare how all Medicare Part D PDP plans in UT cover ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | S |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | Q:8 /28Days |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
AMINOPHYLLINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover AMINOPHYLLINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
AMITIZA CAPSULES 24MCG 60 CAP BOT ![Compare how all Medicare Part D PDP plans in UT cover AMITIZA CAPSULES 24MCG 60 CAP BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover AMITRIPTYLINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT ![Compare how all Medicare Part D PDP plans in UT cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
AMOXIL CAPSULES 500MG ![Compare how all Medicare Part D PDP plans in UT cover AMOXIL CAPSULES 500MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
AMPICILLIN CAPSULES 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN CAPSULES 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover AMPICILLIN CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | 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) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT ![Compare how all Medicare Part D PDP plans in UT cover APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
4 |
Tier 4 |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
4 |
Tier 4 |
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 |
$55.00 | $165.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Tier 4 |
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) |
4 |
Tier 4 |
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) |
4 |
Tier 4 |
33% | 33% | P |
ARANESP PREFILLED SYRINGE SINGLE USE 100MCG/0.5ML 1 SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 100MCG/0.5ML 1 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
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) |
4 |
Tier 4 |
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 |
$55.00 | $165.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | 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) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 60MCG/0.3ML 60MCG/ 0.3ML SYR ![Compare how all Medicare Part D PDP plans in UT cover ARANESP PREFILLED SYRINGE SINGLE USE 60MCG/0.3ML 60MCG/ 0.3ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
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) |
4 |
Tier 4 |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | P |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | 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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
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) |
3 |
Tier 3 |
$55.00 | $165.00 | None |
ATAMET ![Compare how all Medicare Part D PDP plans in UT cover ATAMET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | None |
ATENOLOL TABLETS USP 100MG 1 BLPK ![Compare how all Medicare Part D PDP plans in UT cover ATENOLOL TABLETS USP 100MG 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $15.00 | None |
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 |
$5.00 | $15.00 | 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 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
AUGMENTIN TABLETS COMBO ![Compare how all Medicare Part D PDP plans in UT cover AUGMENTIN TABLETS COMBO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
4 |
Tier 4 |
33% | 33% | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:2 /30Days |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | 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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:6 /5Days |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:6 /5Days |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | P |
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) |
1 |
Tier 1 |
$5.00 | $15.00 | Q:6 /5Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZMACORT INHALATION AEROSOL .1MG/1IHL 20 GM CSTR ![Compare how all Medicare Part D PDP plans in UT cover AZMACORT INHALATION AEROSOL .1MG/1IHL 20 GM CSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | 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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |
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) |
2 |
Tier 2 |
$25.00 | $75.00 | None |