2010 Medicare Part D Plan Formulary Information |
MedicareRx Rewards Standard (PDP) (S5960-139-0)
Benefit Details
![Email Prescription and/or Health Benefit details for MedicareRx Rewards Standard (PDP). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The MedicareRx Rewards Standard (PDP) (S5960-139-0) Formulary Drugs Starting with the Letter C in CMS PDP Region 33 which includes: HI
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CABERGOLINE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CALCIJEX 1 MCG/ML AMPUL ![Compare how all Medicare Part D PDP plans in HI cover CALCIJEX 1 MCG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CALCIPOTRIENE TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CALCIPOTRIENE TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:60 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in HI cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:4 /30Days |
CALCITRIOL 0.25MCG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 0.25MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CALCITRIOL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CALCITRIOL 2 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 2 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CAMILA 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAMILA 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAMPATH 30MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CAMPATH 30MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CAMPRAL 333MG DOSE PAK ![Compare how all Medicare Part D PDP plans in HI cover CAMPRAL 333MG DOSE PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CAMPTOSAR 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CAMPTOSAR 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in HI cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CAPASTAT SULFATE 1GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CAPASTAT SULFATE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL/HCTZ 25/15 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL/HCTZ 25/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL/HCTZ 25/25 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL/HCTZ 25/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL/HCTZ 50/15 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL/HCTZ 50/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CAPTOPRIL/HCTZ 50/25 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL/HCTZ 50/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARAC CRE 0.5% ![Compare how all Medicare Part D PDP plans in HI cover CARAC CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CARBAMAZEPINE 100MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE 100MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:60 /30Days |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBATROL 100MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARBATROL 100MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBATROL 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARBATROL 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:240 /30Days |
CARBATROL 300MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARBATROL 300MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:150 /30Days |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBINOXAMINE MALEATE SOLUTION 4MG/5ML 16 OZ BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBINOXAMINE MALEATE SOLUTION 4MG/5ML 16 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBINOXAMINE MALEATE TABLETS 4MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBINOXAMINE MALEATE TABLETS 4MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARBOPLATIN AQUEOUS SOLUTION INJECTION 150MG 15ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CARBOPLATIN AQUEOUS SOLUTION INJECTION 150MG 15ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CARDENE IV INJECTION 2.5MG/ML 10 X 10 ML AMP ![Compare how all Medicare Part D PDP plans in HI cover CARDENE IV INJECTION 2.5MG/ML 10 X 10 ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CARIMUNE NF 3GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CARIMUNE NF 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
CARISOPRODOL AND ASPIRIN TABLETS USP 325;200MG;MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL AND ASPIRIN TABLETS USP 325;200MG;MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE TABLETS USP 325;200;16MG;MG;MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE TABLETS USP 325;200;16MG;MG;MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARISOPRODOL TABLET USP 350MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL TABLET USP 350MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARNITOR 1GM/5ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CARNITOR 1GM/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARTIA XT 300MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 300MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARVEDILOL 12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARVEDILOL 12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARVEDILOL 25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARVEDILOL 25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARVEDILOL 3.125MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARVEDILOL 3.125MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CARVEDILOL 6.25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARVEDILOL 6.25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEENU 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CEENU 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CEENU 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CEFACLOR 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:450 /1Days |
CEFACLOR 375MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR 375MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:300 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR CAPSULES USP 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR CAPSULES USP 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFACLOR CAPSULES USP 500MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR CAPSULES USP 500MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFACLOR ER 500MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR ER 500MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:42 /1Days |
CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:42 /1Days |
CEFADROXIL 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFAZOLIN 1GM/D5W BAG ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN 1GM/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFAZOLIN 20GM BULK VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN 20GM BULK VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFAZOLIN 500MG/D5W BAG ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN 500MG/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFAZOLIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFAZOLIN FOR INJECTION 1MG 25 VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN FOR INJECTION 1MG 25 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:42 /1Days |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFEPIME HCL 2 GRAM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFEPIME HCL 2 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFEPIME INJ 1GM 20ML APX 10x1G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFIZOX 1GM IN D5W 50ML ![Compare how all Medicare Part D PDP plans in HI cover CEFIZOX 1GM IN D5W 50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFIZOX 2GM IN D5W 50ML ![Compare how all Medicare Part D PDP plans in HI cover CEFIZOX 2GM IN D5W 50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTAXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFOTAXIME FOR INJECTION 2GM 25 VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 2GM 25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTAXIME FOR INJECTION 500MG 10 VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 500MG 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTETAN 10 GM SOLR ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 10 GM SOLR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTETAN 1GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 1GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOTETAN 2GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 2GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOXITIN FOR INJECTION 1 GM/50ML ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION 1 GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOXITIN FOR INJECTION 10GM 10 X 100ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION 10GM 10 X 100ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOXITIN FOR INJECTION 1GM 25 X 20ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION 1GM 25 X 20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOXITIN FOR INJECTION 2GM 20ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION 2GM 20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFOXITIN FOR INJECTION 2MG/50ML 50 ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION 2MG/50ML 50 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFPODOXIME PROXETIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME PROXETIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFPROZIL 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:300 /1Days |
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFPROZIL TABLETS 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL TABLETS 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFTAZIDIME FOR INJECTION 1GM/VIAL 1 SINGLE VIAL VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFTAZIDIME FOR INJECTION 1GM/VIAL 1 SINGLE VIAL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN ![Compare how all Medicare Part D PDP plans in HI cover CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN ![Compare how all Medicare Part D PDP plans in HI cover CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTRIAXONE 10GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 1 GM/50ML ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 1 GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 2 GM/50ML ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 2 GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CEFUROXIME 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFUROXIME AXETIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME AXETIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEFUROXIME AXETIL 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME AXETIL 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:42 /1Days |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFUROXIME FOR INJECTION 7.5GM 10 X 7.5 VIALPHR ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION 7.5GM 10 X 7.5 VIALPHR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CELLCEPT 200MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT 200MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
CELLCEPT 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
CELLCEPT IV INJ 500MG ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT IV INJ 500MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CELONTIN 300MG KAPSEAL ![Compare how all Medicare Part D PDP plans in HI cover CELONTIN 300MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CEPHALEXIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEPHALEXIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEPHALEXIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEPHALEXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEPHALEXIN CAPSULES 500MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN CAPSULES 500MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CEREBYX 50MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEREBYX 50MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CEREDASE 80UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEREDASE 80UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CEREZYME INJ 200UNIT ![Compare how all Medicare Part D PDP plans in HI cover CEREZYME INJ 200UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CERUBIDINE 20MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CERUBIDINE 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CESIA 7 DAYS X 3 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CESIA 7 DAYS X 3 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:28 /28Days |
CETIRIZINE HCL 5MG/5ML ![Compare how all Medicare Part D PDP plans in HI cover CETIRIZINE HCL 5MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:300 /30Days |
CHANTIX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CHANTIX 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CHANTIX STARTING MONTH PAK ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX STARTING MONTH PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CHLORAMPHEN NA SUCC 1GM VL ![Compare how all Medicare Part D PDP plans in HI cover CHLORAMPHEN NA SUCC 1GM VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in HI cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLOROQUINE PH 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROQUINE PH 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLOROTHIAZIDE 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROTHIAZIDE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLOROTHIAZIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROTHIAZIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORPROMAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:120 /30Days |
CHLORPROMAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:120 /30Days |
CHLORPROMAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:120 /30Days |
CHLORPROMAZINE 25MG/ML AMP ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 25MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CHLORPROMAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORPROPAMIDE 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROPAMIDE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORPROPAMIDE 250MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROPAMIDE 250MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORTHALIDONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORTHALIDONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORTHALIDONE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORTHALIDONE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORZOXAZONE 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORZOXAZONE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHLORZOXAZONE 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORZOXAZONE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 210GM CAN ![Compare how all Medicare Part D PDP plans in HI cover CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 210GM CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 60 X 5 SINGLE DOSE CRTN ![Compare how all Medicare Part D PDP plans in HI cover CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 60 X 5 SINGLE DOSE CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 60 X 9GM SINGLE DOSE CRTN ![Compare how all Medicare Part D PDP plans in HI cover CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 60 X 9GM SINGLE DOSE CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 378GM CAN ![Compare how all Medicare Part D PDP plans in HI cover CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 378GM CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CICLOPIROX 0.77% CREAM ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX 0.77% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CICLOPIROX 0.77% GEL ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX 0.77% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CICLOPIROX 0.77% TOPICAL SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX 0.77% TOPICAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CILOSTAZOL 50MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CILOSTAZOL 50MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIMETIDINE 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CIMETIDINE 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIMETIDINE HCL 300MG/5ML SOL ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE HCL 300MG/5ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIMETIDINE TABLET USP 300MG (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE TABLET USP 300MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIMETIDINE TABLET USP 400MG (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE TABLET USP 400MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIMETIDINE TABLET USP 800MG (30 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE TABLET USP 800MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIMZIA KIT ![Compare how all Medicare Part D PDP plans in HI cover CIMZIA KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P Q:4 /30Days |
CIPRO IV INFUSION 200MG 100ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CIPRO IV INFUSION 200MG 100ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CIPROFLOXACIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CIPROFLOXACIN 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIPROFLOXACIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIPROFLOXACIN ER 1000MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN ER 1000MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:14 /1Days |
CIPROFLOXACIN ER 500MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN ER 500MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:3 /1Days |
CIPROFLOXACIN HCL 0.3% DROPS ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN HCL 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CIPROFLOXACIN HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN TABLETS 750MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN TABLETS 750MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CISPLATIN INJECTION 1MG ![Compare how all Medicare Part D PDP plans in HI cover CISPLATIN INJECTION 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CITALOPRAM HBR 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HBR 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:30 /30Days |
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:600 /30Days |
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:30 /30Days |
CITOLOPRAM HBR 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CITOLOPRAM HBR 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:30 /30Days |
CLADRIBINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLADRIBINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
CLAFORAN 10GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLAFORAN 1GM/50ML GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN 1GM/50ML GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLAFORAN 2GM/50ML GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN 2GM/50ML GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLAFORAN 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLAFORAN INJECTION STERILE 2GM 10 X 2GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN INJECTION STERILE 2GM 10 X 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLARAVIS 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLARAVIS 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLARAVIS 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLARAVIS 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLARITHROMYCIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:42 /1Days |
CLARITHROMYCIN 250MG/5ML. SUS. 100ML ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN 250MG/5ML. SUS. 100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLARITHROMYCIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:28 /1Days |
CLARITHROMYCIN ER 500MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN ER 500MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:28 /1Days |
CLARITHROMYCIN FOR ORAL SUSPENSION 125/5ML 125MG BOT ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN FOR ORAL SUSPENSION 125/5ML 125MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:200 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLEMASTINE FUM 2.68MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLEMASTINE FUM 2.68MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLEMASTINE FUMARATE 0.67MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in HI cover CLEMASTINE FUMARATE 0.67MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLEOCIN 300MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 300MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLEOCIN 600MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 600MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLEOCIN 900MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 900MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLEOCIN PHOS 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN PHOS 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG ![Compare how all Medicare Part D PDP plans in HI cover CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:4 /28Days |
CLINDAMYCIN 150MG/ML ADDVAN ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN 150MG/ML ADDVAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CLINDAMYCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINDAMYCIN HCL 300MG CAPS ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN HCL 300MG CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINDAMYCIN PHOSP 1% LOTION ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSP 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINDAMYCIN PHOSPHATE 2% CREAM WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE 2% CREAM WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLINIMIX 2.75%/5% INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 2.75%/5% INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 4.25/10 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 4.25/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 5/15 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/15 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 2.75/10 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 2.75/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 5/25 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 5/35 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5/35 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINIMIX E 5%/15% INJECTION 2000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5%/15% INJECTION 2000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLINISOL 15% SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINISOL 15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBETASOL 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOBETASOL PROPIONATE 0.05% FOAM ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL PROPIONATE 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOBETASOL PROPIONATE CRM 0.05% 15GM ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL PROPIONATE CRM 0.05% 15GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOLAR 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLOLAR 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:300 /30Days |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:300 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CREAM USP .5MG-10GM 45GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CREAM USP .5MG-10GM 45GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CLOZAPINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:120 /30Days |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:90 /30Days |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:90 /30Days |
CLOZAPINE TABLETS 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE TABLETS 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:270 /30Days |
COGENTIN 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in HI cover COGENTIN 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLCHICINE TABLET USP 0.6MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover COLCHICINE TABLET USP 0.6MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in HI cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COLESTIPOL HCL 5G GRANULES ![Compare how all Medicare Part D PDP plans in HI cover COLESTIPOL HCL 5G GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COLISTIMETHATE 150MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover COLISTIMETHATE 150MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COLOCORT 100MG ENEMA ![Compare how all Medicare Part D PDP plans in HI cover COLOCORT 100MG ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COLY MYCIN M FOR INJECTION 150MG/VIAL 5 ML VIALSD ![Compare how all Medicare Part D PDP plans in HI cover COLY MYCIN M FOR INJECTION 150MG/VIAL 5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
COMBIVENT INHALER ![Compare how all Medicare Part D PDP plans in HI cover COMBIVENT INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:45 /30Days |
COMBIVIR TABLET ![Compare how all Medicare Part D PDP plans in HI cover COMBIVIR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in HI cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COMTAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COMTAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in HI cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CONSTULOSE 10GM/15ML SYRUP ![Compare how all Medicare Part D PDP plans in HI cover CONSTULOSE 10GM/15ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in HI cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | P |
COPEGUS 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COPEGUS 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CORDARONE 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CORDARONE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CORTISONE ACETATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CORTISONE ACETATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CORTOMYCIN EAR SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CORTOMYCIN EAR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CORTOMYCIN EAR SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CORTOMYCIN EAR SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
COSMEGEN 0.5MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover COSMEGEN 0.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
COUMADIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COUMADIN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 2MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 3MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 5MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
COUMADIN 6MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
COUMADIN 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COUMADIN 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CRIXIVAN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CRIXIVAN 333MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 333MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CRIXIVAN 400MG CAPSULE (120 CT) ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 400MG CAPSULE (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CROMOLYN NEBULIZER SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CROMOLYN NEBULIZER SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CRYSELLE-28 TABLET 28 TABLET S ![Compare how all Medicare Part D PDP plans in HI cover CRYSELLE-28 TABLET 28 TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | Q:28 /28Days |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty Drugs |
25% | N/A | None |
CUPRIMINE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CUPRIMINE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CUPRIMINE CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CUPRIMINE CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYCLOBENZAPRINE HCL 5MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CYCLOPHOSPHAMIDE 1GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CYCLOPHOSPHAMIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOPHOSPHAMIDE 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CYCLOPHOSPHAMIDE 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOSPORINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
CYCLOSPORINE 50MG/ML AMP ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 50MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYKLOKAPRON 100MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in HI cover CYKLOKAPRON 100MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CYMBALTA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYMBALTA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:60 /30Days |
CYMBALTA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYMBALTA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:30 /30Days |
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | Q:60 /30Days |
CYPROHEPTADINE 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CYPROHEPTADINE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in HI cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$6.50 | $9.75 | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in HI cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
25% | 25% | None |
CYTARABINE 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CYTARABINE 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CYTOVENE 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTOVENE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | P |
CYTOXAN 2GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTOXAN 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |
CYTOXAN 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTOXAN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Specialty Injectable Drugs |
25% | 25% | None |