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 S in CMS PDP Region 15 which includes: IN KY
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SAIZEN 5MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SAIZEN 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SAIZEN 8.8MG CLICK.EASY CARTG ![Compare how all Medicare Part D PDP plans in IN cover SAIZEN 8.8MG CLICK.EASY CARTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SALAGEN 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SALAGEN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SALAGEN 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SALAGEN 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SANCTURA 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SANCTURA 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
SANCTURA XR 60MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in IN cover SANCTURA XR 60MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in IN cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /2Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SANDIMMUNE 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | P |
SANDOSTATIN 0.05MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN 0.05MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN 0.1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN 0.1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN 0.2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN 0.2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN 0.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN 0.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P Q:2 /1Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P Q:2 /1Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P Q:55 /365Days |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P Q:2 /1Days |
SEASONALE 0.15-0.03 TABLET DOSE PACK 3 MONTHS ![Compare how all Medicare Part D PDP plans in IN cover SEASONALE 0.15-0.03 TABLET DOSE PACK 3 MONTHS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS ![Compare how all Medicare Part D PDP plans in IN cover SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
SECTRAL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SECTRAL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SECTRAL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SECTRAL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SELSUN RX 2.5% SHAMPOO ![Compare how all Medicare Part D PDP plans in IN cover SELSUN RX 2.5% SHAMPOO.](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 |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SEMPREX-D 60/8 CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SEMPREX-D 60/8 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SEPTRA 80/400 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEPTRA 80/400 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SEPTRA DS TABLET 800-160 ![Compare how all Medicare Part D PDP plans in IN cover SEPTRA DS TABLET 800-160.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in IN cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SEROMYCIN CAPSULES 250MG ![Compare how all Medicare Part D PDP plans in IN cover SEROMYCIN CAPSULES 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:3 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:4 /1Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:6 /1Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:3 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in IN cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SEROSTIM 4MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SEROSTIM 4MG VIAL.](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 |
SEROSTIM 5MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SEROSTIM 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SEROSTIM 6MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SEROSTIM 6MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:2 /1Days |
SERTRALINE HCL 20MG/ML CONCENTRATE ORAL ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 20MG/ML CONCENTRATE ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:10 /1Days |
SERTRALINE HCL 25MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 25MG TABLET (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 |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:2 /1Days |
SILVADENE 1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover SILVADENE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in IN cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IN cover SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IN cover SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IN cover SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in IN cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 10MG TABLET (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 |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SINEMET CR 25/100 TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover SINEMET CR 25/100 TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SINEMET CR 50/200 TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover SINEMET CR 50/200 TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SINEMET-10/100 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SINEMET-10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SINEMET-25/100 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SINEMET-25/100 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 |
SINEMET-25/250 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SINEMET-25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SKELAXIN 800MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SKELAXIN 800MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SKELID 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SKELID 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in IN cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM CHLORIDE INJECTION 3% 24X500ML BAG ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE INJECTION 3% 24X500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM CHLORIDE INJECTION 5% ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE INJECTION 5%.](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 |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SODIUM LACTATE 1/6MOLAR INJ ![Compare how all Medicare Part D PDP plans in IN cover SODIUM LACTATE 1/6MOLAR INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in IN cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in IN cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SOLODYN 135MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOLODYN 135MG 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 |
SOLODYN 45MG TABLET SR 24HR (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SOLODYN 45MG TABLET SR 24HR (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SOLODYN 90MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOLODYN 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SOLU-CORTEF 100MG ACT-O-VL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-CORTEF 100MG ACT-O-VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOLU-CORTEF 250MG ACT-O-VL (2ML) VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-CORTEF 250MG ACT-O-VL (2ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOLU-MEDROL 125MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-MEDROL 125MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOLU-MEDROL 2000MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-MEDROL 2000MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOLU-MEDROL 40MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-MEDROL 40MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOLU-MEDROL 500MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-MEDROL 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SOMA 250MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOMA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SOMA 350MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOMA 350MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM ![Compare how all Medicare Part D PDP plans in IN cover SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM.](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 |
SOMATULINE DEPOT FOR INJECTION 120MG/0.5ML ![Compare how all Medicare Part D PDP plans in IN cover SOMATULINE DEPOT FOR INJECTION 120MG/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SONATA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SONATA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
SONATA 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SONATA 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
SORIATANE 25MG ![Compare how all Medicare Part D PDP plans in IN cover SORIATANE 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SORIATANE CK 25MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SORIATANE CK 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](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 |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in IN cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SPECTRACEF 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPECTRACEF 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SPECTRACEF 400 MG DOSE PACK TB ![Compare how all Medicare Part D PDP plans in IN cover SPECTRACEF 400 MG DOSE PACK TB.](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 |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in IN cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SPORANOX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SPORANOX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SPORANOX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SPORANOX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 50MG TABLET.](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 |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STADOL 2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover STADOL 2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:8 /1Days |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:8 /1Days |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:8 /1Days |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:8 /1Days |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:6 /1Days |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:8 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STARLIX 120MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STARLIX 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STARLIX 60MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STARLIX 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STAVZOR 125MG CPDR ![Compare how all Medicare Part D PDP plans in IN cover STAVZOR 125MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STAVZOR 250MG CPDR ![Compare how all Medicare Part D PDP plans in IN cover STAVZOR 250MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STAVZOR 500MG CPDR ![Compare how all Medicare Part D PDP plans in IN cover STAVZOR 500MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STERAPRED 5MG TABLET UNIPAK ![Compare how all Medicare Part D PDP plans in IN cover STERAPRED 5MG TABLET UNIPAK.](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 |
STERAPRED 5MG TABLET UNIPAK ![Compare how all Medicare Part D PDP plans in IN cover STERAPRED 5MG TABLET UNIPAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STERAPRED DS 21 DAY UNI PACK TABLETS 10MG ![Compare how all Medicare Part D PDP plans in IN cover STERAPRED DS 21 DAY UNI PACK TABLETS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in IN cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in IN cover STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
STIMATE 1.5MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IN cover STIMATE 1.5MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in IN cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
STRIANT 30MG MUCOADHESIVE ![Compare how all Medicare Part D PDP plans in IN cover STRIANT 30MG MUCOADHESIVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:2 /1Days |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
STROMECTOL 6MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STROMECTOL 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SUBUTEX 2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBUTEX 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SUBUTEX 8MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBUTEX 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
SUCRAID 8500UNITS/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover SUCRAID 8500UNITS/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUCRALFATE 1GM 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 |
SULAR 17MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover SULAR 17MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SULAR 25.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover SULAR 25.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SULAR 34MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover SULAR 34MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SULAR 8.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover SULAR 8.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SULF-10 OPHTHALMIC SOLUTION 10% ![Compare how all Medicare Part D PDP plans in IN cover SULF-10 OPHTHALMIC SOLUTION 10%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:20 /10Days |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](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 |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFAMYLON 50G PACKET ![Compare how all Medicare Part D PDP plans in IN cover SULFAMYLON 50G PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SULFAMYLON CREAM 85GM 4 OZ TUBE ![Compare how all Medicare Part D PDP plans in IN cover SULFAMYLON CREAM 85GM 4 OZ TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:4 /1Days |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFATRIM PEDIATRIC SUSP ![Compare how all Medicare Part D PDP plans in IN cover SULFATRIM PEDIATRIC SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULFAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN.](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 |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | Q:4 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | None |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SURMONTIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SURMONTIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 200MG CAPSULE.](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 |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | None |
SUSTIVA TABLETS 600MG ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA TABLETS 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$5.00 | $10.00 | Q:1 /1Days |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in IN cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in IN cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYMBYAX 12-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 12-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SYMBYAX 12-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 12-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SYMBYAX 3MG-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 3MG-25MG CAPSULE.](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 |
SYMBYAX 6-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 6-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SYMBYAX 6-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 6-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $70.00 | Q:1 /1Days |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | P |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in IN cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | P |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | P |
SYNALGOS-DC CAPSULE 356.4MG/30MG ![Compare how all Medicare Part D PDP plans in IN cover SYNALGOS-DC CAPSULE 356.4MG/30MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IN cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
33% | N/A | None |
SYNERA DIS 70-70MG ![Compare how all Medicare Part D PDP plans in IN cover SYNERA DIS 70-70MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
33% | N/A | None |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 112 MCG 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 |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 137MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 137MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |