2010 Medicare Part D Plan Formulary Information |
Health Net Orange Option 2 (PDP) (S5678-035-0)
Benefit Details
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The Health Net Orange Option 2 (PDP) (S5678-035-0) Formulary Drugs Starting with the Letter O in CMS PDP Region 15 which includes: IN KY
|
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCELLA TABLET ![Compare how all Medicare Part D PDP plans in IN cover OCELLA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG ![Compare how all Medicare Part D PDP plans in IN cover OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in IN cover OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in IN cover OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP ![Compare how all Medicare Part D PDP plans in IN cover OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | P |
OCUFEN 0.03% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover OCUFEN 0.03% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OCUFLOX 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover OCUFLOX 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OCUSULF-10 EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover OCUSULF-10 EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in IN cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OFLOXACIN 0.3% DROPS ![Compare how all Medicare Part D PDP plans in IN cover OFLOXACIN 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OFLOXACIN 200MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in IN cover OFLOXACIN 200MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OFLOXACIN 300MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in IN cover OFLOXACIN 300MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OFLOXACIN 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover OFLOXACIN 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in IN cover OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OGEN 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OGEN 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OGEN 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OGEN 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OGEN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OGEN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OGESTREL TABLET 0.05MG/0.5MG ![Compare how all Medicare Part D PDP plans in IN cover OGESTREL TABLET 0.05MG/0.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
OLOPATADINE HCL 0.6% SPRAY SOLUTION NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IN cover OLOPATADINE HCL 0.6% SPRAY SOLUTION NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLUX-E 0.05% FOAM ![Compare how all Medicare Part D PDP plans in IN cover OLUX-E 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
OMEPRAZOLE 20MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover OMEPRAZOLE 20MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:2 /1Days |
OMEPRAZOLE DR CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover OMEPRAZOLE DR CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | S Q:1 /1Days |
OMNARIS 50MCG SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in IN cover OMNARIS 50MCG SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OMNICEF 125MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in IN cover OMNICEF 125MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OMNICEF 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover OMNICEF 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OMNICEF SUS 250/5ML ![Compare how all Medicare Part D PDP plans in IN cover OMNICEF SUS 250/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OMNIPRED OPHTHALMIC SUSPENSION 1% 10 ML BOTPL ![Compare how all Medicare Part D PDP plans in IN cover OMNIPRED OPHTHALMIC SUSPENSION 1% 10 ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:10 /10Days |
OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM ![Compare how all Medicare Part D PDP plans in IN cover OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG ![Compare how all Medicare Part D PDP plans in IN cover OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in IN cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
ONCASPAR 750UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover ONCASPAR 750UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
ONDANSETRON HCL 24MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON HCL 24MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONDANSETRON HCL 4MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON HCL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONDANSETRON HCL 4MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON HCL 4MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONDANSETRON HCL 8MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON HCL 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONDANSETRON INJECTION 2MG 5X2ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON INJECTION 2MG 5X2ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | P |
ONDANSETRON ODT 4MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON ODT 4MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONDANSETRON ODT 8MG (10 CT) ![Compare how all Medicare Part D PDP plans in IN cover ONDANSETRON ODT 8MG (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
ONTAK INJECTION 300MCG/2ML VIALSU ![Compare how all Medicare Part D PDP plans in IN cover ONTAK INJECTION 300MCG/2ML VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
ONXOL PACLITAXEL INJECTION 6MG/ML 5 ML VIALGL ![Compare how all Medicare Part D PDP plans in IN cover ONXOL PACLITAXEL INJECTION 6MG/ML 5 ML VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPANA 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:6 /1Days |
OPANA 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:6 /1Days |
OPANA ER 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 15MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 15MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 30MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 30MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPANA ER 7.5MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OPANA ER 7.5MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
OPTIPRANOLOL 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover OPTIPRANOLOL 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OPTIVAR 0.05% DROPS ![Compare how all Medicare Part D PDP plans in IN cover OPTIVAR 0.05% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORACEA CAPSULES 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in IN cover ORACEA CAPSULES 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in IN cover ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P Q:4 /1Days |
ORAP 1MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORAP 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORAP 2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORAP 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORAPRED ODT 10MG TABLET 48 EA ![Compare how all Medicare Part D PDP plans in IN cover ORAPRED ODT 10MG TABLET 48 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORAPRED ODT TABLETS 15MG 14 PKG ![Compare how all Medicare Part D PDP plans in IN cover ORAPRED ODT TABLETS 15MG 14 PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORAPRED ODT TABLETS 30MG 14 CARD PKG ![Compare how all Medicare Part D PDP plans in IN cover ORAPRED ODT TABLETS 30MG 14 CARD PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORAPRED SOLUTION 15MG/5ML 20 ML BOT ![Compare how all Medicare Part D PDP plans in IN cover ORAPRED SOLUTION 15MG/5ML 20 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORENCIA 250MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover ORENCIA 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
ORFADIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover ORFADIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
ORFADIN 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover ORFADIN 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
ORFADIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover ORFADIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
ORPHENADRINE CITRATE ER TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover ORPHENADRINE CITRATE ER TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORPHENADRINE CITRATE INJECTION 3030MG/ML 10ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover ORPHENADRINE CITRATE INJECTION 3030MG/ML 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
ORPHENADRINE COMP FORTE TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORPHENADRINE COMP FORTE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORPHENADRINE COMPOUND 25-385-30 TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORPHENADRINE COMPOUND 25-385-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
ORTHO EVRA DIS WEEK .75MG / 6MG ![Compare how all Medicare Part D PDP plans in IN cover ORTHO EVRA DIS WEEK .75MG / 6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORTHO MICRON TABLET DIALPAK ![Compare how all Medicare Part D PDP plans in IN cover ORTHO MICRON TABLET DIALPAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
ORTHO NOVUM 7 7 7 28 TABLETS 0.035;1;0.MG;MG;MG 6 X 28 DLPK ![Compare how all Medicare Part D PDP plans in IN cover ORTHO NOVUM 7 7 7 28 TABLETS 0.035;1;0.MG;MG;MG 6 X 28 DLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
ORTHO TRI-CYCLEN LO TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORTHO TRI-CYCLEN LO TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
ORTHO-CEPT 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORTHO-CEPT 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
ORTHO-CYCLEN 28 TABLET 28 X 6 EA ![Compare how all Medicare Part D PDP plans in IN cover ORTHO-CYCLEN 28 TABLET 28 X 6 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
ORTHO-EST 0.625 TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORTHO-EST 0.625 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
ORTHO-EST 1.25 TABLET ![Compare how all Medicare Part D PDP plans in IN cover ORTHO-EST 1.25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
ORTHOCLONE OKT-3 5MG/5ML ![Compare how all Medicare Part D PDP plans in IN cover ORTHOCLONE OKT-3 5MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
OSMOPREP TABLET 1.5GM ![Compare how all Medicare Part D PDP plans in IN cover OSMOPREP TABLET 1.5GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OVCON-35 28 TABLET ![Compare how all Medicare Part D PDP plans in IN cover OVCON-35 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
OVCON-50 28 TABLET ![Compare how all Medicare Part D PDP plans in IN cover OVCON-50 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OVIDE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in IN cover OVIDE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in IN cover OXACILLIN 1GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in IN cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
OXACILLIN FOR INJECTION 1 GM ![Compare how all Medicare Part D PDP plans in IN cover OXACILLIN FOR INJECTION 1 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
OXACILLIN INJECTION ![Compare how all Medicare Part D PDP plans in IN cover OXACILLIN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
OXANDRIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXANDRIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
OXANDRIN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXANDRIN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
OXANDROLONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXANDROLONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
OXANDROLONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXANDROLONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | P |
OXAPROZIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXAPROZIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXCARBAZEPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXCARBAZEPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXCARBAZEPINE 300MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in IN cover OXCARBAZEPINE 300MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXCARBAZEPINE 600MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in IN cover OXCARBAZEPINE 600MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXISTAT 1% CREAM 30GM TUBE ![Compare how all Medicare Part D PDP plans in IN cover OXISTAT 1% CREAM 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:4 /1Days |
OXISTAT 1% LOTION ![Compare how all Medicare Part D PDP plans in IN cover OXISTAT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
OXSORALEN 1% LOTION ![Compare how all Medicare Part D PDP plans in IN cover OXSORALEN 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OXSORALEN-ULTRA 10MG CAP ![Compare how all Medicare Part D PDP plans in IN cover OXSORALEN-ULTRA 10MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
OXYBUTYNIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYBUTYNIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
OXYBUTYNIN CHLORIDE SYRUP USP 5MG/5ML 5 ML UNIT DOSE CUP ![Compare how all Medicare Part D PDP plans in IN cover OXYBUTYNIN CHLORIDE SYRUP USP 5MG/5ML 5 ML UNIT DOSE CUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE AND ACETAMINOPHEN CAPSULES 500;5MG;MG 500 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE AND ACETAMINOPHEN CAPSULES 500;5MG;MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
OXYCODONE HCL 30MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE HCL ER TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL ER TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:4 /1Days |
OXYCODONE HCL ER TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL ER TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:4 /1Days |
OXYCODONE HCL ER TABLETS 80MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL ER TABLETS 80MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:4 /1Days |
OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE HCL-IBUPROFEN 400MG-5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HCL-IBUPROFEN 400MG-5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HYDROCHLORIDE AND ACETAMINOPHEN TABLETS 650;10MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HYDROCHLORIDE AND ACETAMINOPHEN TABLETS 650;10MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCODONE/ASA 4.88/325 TABLET ![Compare how all Medicare Part D PDP plans in IN cover OXYCODONE/ASA 4.88/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
OXYCONTIN 10MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 10MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 15MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 15MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 20MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 20MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 30MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 30MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 60MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 60MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
OXYCONTIN 80MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover OXYCONTIN 80MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYTROL 3.9MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in IN cover OXYTROL 3.9MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |