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2010 Medicare Part D Plan (PDP Only) Formulary Browser

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CVS Caremark Complete (PDP) (S5601-103-0)
Tier 1 (175)
Tier 2 (1731)
Tier 3 (887)
Tier 4 (225)
Tier 5 (183)
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Uses Step Therapy:
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Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2010 Medicare Part D Plan Formulary Information
CVS Caremark Complete (PDP) (S5601-103-0)
Benefit Details  
The CVS Caremark Complete (PDP) (S5601-103-0)
Formulary Drugs Starting with the Letter C

in CMS PDP Region 32 which includes: CA
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   2 Generic Tier $7.50$19.00None
CADUET 10MG/10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 10MG/20MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 10MG/40MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 10MG/80MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 2.5MG/10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 2.5MG/20MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 2.5MG/40MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 5MG/10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 5MG/20MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CADUET 5MG/40MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CADUET 5MG/80MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CALCIPOTRIENE TOPICAL SOLUTION   2 Generic Tier $7.50$19.00None
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY   2 Generic Tier $7.50$19.00None
CALCITRIOL 0.25MCG CAPSULE   2 Generic Tier $7.50$19.00None
CALCITRIOL 0.5MCG CAPSULE   2 Generic Tier $7.50$19.00None
CALCITRIOL 1MCG/ML SOLUTION ORAL   2 Generic Tier $7.50$19.00None
CALCITRIOL 2 MCG/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP   2 Generic Tier $7.50$19.00None
CAMILA 0.35MG TABLET   2 Generic Tier $7.50$19.00None
CAMPATH 30MG/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CAMPRAL 333MG DOSE PAK   3 Preferred Brand Tier $39.00$98.00None
CAMPTOSAR 20MG/ML VIAL   5 Specialty Tier 33%N/ANone
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX   3 Preferred Brand Tier $39.00$98.00None
CANCIDAS IV 50MG VIAL   4 Non-Preferred Brand Tier $98.00$270.00None
CANCIDAS IV 70MG VIAL   4 Non-Preferred Brand Tier $98.00$270.00None
CAPASTAT SULFATE 1GM VIAL   4 Non-Preferred Brand Tier $98.00$270.00None
CAPTOPRIL 100MG TABLET   1 Value Generic Tier $2.50$5.00None
CAPTOPRIL 12.5MG TABLET   1 Value Generic Tier $2.50$5.00None
CAPTOPRIL 25MG TABLET   1 Value Generic Tier $2.50$5.00None
CAPTOPRIL 50MG TABLET   1 Value Generic Tier $2.50$5.00None
CAPTOPRIL/HCTZ 25/15 TABLET   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CAPTOPRIL/HCTZ 25/25 TABLET   2 Generic Tier $7.50$19.00None
CAPTOPRIL/HCTZ 50/15 TABLET   2 Generic Tier $7.50$19.00None
CAPTOPRIL/HCTZ 50/25 TABLET   2 Generic Tier $7.50$19.00None
CARAC CRE 0.5%   3 Preferred Brand Tier $39.00$98.00None
CARAFATE SUS 1GM/10ML   3 Preferred Brand Tier $39.00$98.00None
CARBAMAZEPINE 100MG/5ML SUSPENSION ORAL   2 Generic Tier $7.50$19.00None
CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG   2 Generic Tier $7.50$19.00None
CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG   2 Generic Tier $7.50$19.00None
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT)   2 Generic Tier $7.50$19.00None
CARBAMAZEPINE TABLET USP 200MG (1000 CT)   2 Generic Tier $7.50$19.00None
CARBATROL 100MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARBATROL 200MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
CARBATROL 300MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT   2 Generic Tier $7.50$19.00None
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT   2 Generic Tier $7.50$19.00None
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT   2 Generic Tier $7.50$19.00None
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA   2 Generic Tier $7.50$19.00None
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA   2 Generic Tier $7.50$19.00None
CARBIDOPA/LEVO 10/100 TABLET   2 Generic Tier $7.50$19.00None
CARBIDOPA/LEVO 25/100 TABLET   2 Generic Tier $7.50$19.00None
CARBIDOPA/LEVO 25/250 TABLET   2 Generic Tier $7.50$19.00None
CARBOPLATIN AQUEOUS SOLUTION INJECTION 150MG 15ML VIAL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARDIZEM CD 360MG CAPSULE SR 24 HR   3 Preferred Brand Tier $39.00$98.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 120MG 90 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 180MG 90 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 240MG 90 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 300MG 90 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 360MG 30 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARDIZEM LA EXTENDED RELEASE TABLETS 420MG 30 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CARISOPRODOL AND ASPIRIN TABLETS USP 325;200MG;MG 100 BOTPL   2 Generic Tier $7.50$19.00None
CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE TABLETS USP 325;200;16MG;MG;MG 100 BOTPL   2 Generic Tier $7.50$19.00None
CARISOPRODOL TABLET USP 350MG (100 CT)   2 Generic Tier $7.50$19.00None
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARTIA XT 120MG CAPSULE SA   2 Generic Tier $7.50$19.00None
CARTIA XT 180MG CAPSULE SA   2 Generic Tier $7.50$19.00None
CARTIA XT 240MG CAPSULE SA   2 Generic Tier $7.50$19.00None
CARTIA XT 300MG CAPSULE SR 24 HR   2 Generic Tier $7.50$19.00None
CARVEDILOL 12.5MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CARVEDILOL 25MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CARVEDILOL 3.125MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CARVEDILOL 6.25MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CATAPRES-TTS DIS 0.3/24HR   3 Preferred Brand Tier $39.00$98.00None
CATAPRES-TTS-1 PATCH 2.52.5MG/UNT 1 X 4 CRTN   3 Preferred Brand Tier $39.00$98.00None
CATAPRES-TTS-2 PATCH 52.5MG/UNT 1 X 4 CRTN   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEDAX 400MG CAPSULE   4 Non-Preferred Brand Tier $98.00$270.00None
CEDAX 90MG/5ML SUSPENSION RECONSTITUTED ORAL   4 Non-Preferred Brand Tier $98.00$270.00None
CEENU 100MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CEENU 10MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CEENU 40MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CEFACLOR 250MG/5ML ORAL SUSP   2 Generic Tier $7.50$19.00None
CEFACLOR 375MG/5ML ORAL SUSP   2 Generic Tier $7.50$19.00None
CEFACLOR CAPSULES USP 250MG (100 CT)   2 Generic Tier $7.50$19.00None
CEFACLOR CAPSULES USP 500MG (100 CT)   2 Generic Tier $7.50$19.00None
CEFACLOR ER 500MG TABLET SR 12HR   2 Generic Tier $7.50$19.00None
CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFADROXIL 1G TABLET   2 Generic Tier $7.50$19.00None
CEFADROXIL 500MG CAPSULE   2 Generic Tier $7.50$19.00None
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   2 Generic Tier $7.50$19.00None
CEFAZOLIN 1GM/D5W BAG   3 Preferred Brand Tier $39.00$98.00None
CEFAZOLIN 20GM BULK VIAL   2 Generic Tier $7.50$19.00None
CEFAZOLIN 500MG/D5W BAG   3 Preferred Brand Tier $39.00$98.00None
CEFAZOLIN FOR INJECTION   2 Generic Tier $7.50$19.00None
CEFAZOLIN FOR INJECTION 1MG 25 VIALGL   2 Generic Tier $7.50$19.00None
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
CEFDINIR CAPSULES 300MG (60 CT)   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT)   2 Generic Tier $7.50$19.00None
CEFEPIME HCL 2 GRAM VIAL   2 Generic Tier $7.50$19.00None
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL   2 Generic Tier $7.50$19.00None
CEFOTAXIME FOR INJECTION   2 Generic Tier $7.50$19.00None
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL   2 Generic Tier $7.50$19.00None
CEFOTAXIME FOR INJECTION 2GM 25 VIAL   2 Generic Tier $7.50$19.00None
CEFOTAXIME FOR INJECTION 500MG 10 VIAL   2 Generic Tier $7.50$19.00None
CEFOXITIN FOR INJECTION 10GM 10 X 100ML VIAL   2 Generic Tier $7.50$19.00None
CEFOXITIN FOR INJECTION 1GM 25 X 20ML VIAL   2 Generic Tier $7.50$19.00None
CEFOXITIN FOR INJECTION 2GM 20ML VIAL   2 Generic Tier $7.50$19.00None
CEFPODOXIME PROXETIL 200MG TABLET   2 Generic Tier $7.50$19.00None
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)   2 Generic Tier $7.50$19.00None
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT   2 Generic Tier $7.50$19.00None
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT   2 Generic Tier $7.50$19.00None
CEFPROZIL 250MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT   2 Generic Tier $7.50$19.00None
CEFPROZIL TABLETS 500MG 100 BOT   2 Generic Tier $7.50$19.00None
CEFTRIAXONE 10GM VIAL   2 Generic Tier $7.50$19.00None
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL   2 Generic Tier $7.50$19.00None
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL   2 Generic Tier $7.50$19.00None
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 1 GM/50ML   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFTRIAXONE FOR INJECTION AND DEXTROSE INJECTION 2 GM/50ML   2 Generic Tier $7.50$19.00None
CEFUROXIME 250MG TABLET   2 Generic Tier $7.50$19.00None
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
CEFUROXIME AXETIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
CEFUROXIME AXETIL 500MG TABLET (20 CT)   2 Generic Tier $7.50$19.00None
CEFUROXIME FOR INJECTION   2 Generic Tier $7.50$19.00None
CEFUROXIME FOR INJECTION   2 Generic Tier $7.50$19.00None
CEFUROXIME FOR INJECTION 7.5GM 10 X 7.5 VIALPHR   2 Generic Tier $7.50$19.00None
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION   3 Preferred Brand Tier $39.00$98.00None
CELEBREX 100MG CAPSULE   3 Preferred Brand Tier $39.00$98.00P
CELEBREX 200MG CAPSULE   3 Preferred Brand Tier $39.00$98.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CELEBREX 400MG CAPSULE   3 Preferred Brand Tier $39.00$98.00P
CELEBREX 50MG CAPSULE   3 Preferred Brand Tier $39.00$98.00P
CELLCEPT 200MG/ML ORAL SUSP   3 Preferred Brand Tier $39.00$98.00P
CELLCEPT 500MG TABLET   3 Preferred Brand Tier $39.00$98.00P
CELLCEPT CAPSULES 250MG (500 CT)   3 Preferred Brand Tier $39.00$98.00P
CELONTIN 300MG KAPSEAL   3 Preferred Brand Tier $39.00$98.00None
CENESTIN 0.3MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CENESTIN 0.45MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CENESTIN 0.625MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CENESTIN 0.9MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
CENESTIN 1.25MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEPHALEXIN 250MG CAPSULE   2 Generic Tier $7.50$19.00None
CEPHALEXIN 250MG TABLET   2 Generic Tier $7.50$19.00None
CEPHALEXIN 250MG/5ML ORAL SUSP   2 Generic Tier $7.50$19.00None
CEPHALEXIN 500MG TABLET   2 Generic Tier $7.50$19.00None
CEPHALEXIN CAPSULES 500MG (500 CT)   2 Generic Tier $7.50$19.00None
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT   2 Generic Tier $7.50$19.00None
CEREZYME INJ 200UNIT   5 Specialty Tier 33%N/ANone
CESIA 7 DAYS X 3 TABLET   2 Generic Tier $7.50$19.00None
CHANTIX 0.5MG TABLET   3 Preferred Brand Tier $39.00$98.00P
CHANTIX 1MG TABLET   3 Preferred Brand Tier $39.00$98.00P
CHANTIX STARTING MONTH PAK   3 Preferred Brand Tier $39.00$98.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHLORAMPHEN NA SUCC 1GM VL   2 Generic Tier $7.50$19.00None
CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT)   2 Generic Tier $7.50$19.00None
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH   2 Generic Tier $7.50$19.00None
CHLOROQUINE PH 500MG TABLET   2 Generic Tier $7.50$19.00None
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT)   2 Generic Tier $7.50$19.00None
CHLOROTHIAZIDE 250MG TABLET   2 Generic Tier $7.50$19.00None
CHLOROTHIAZIDE 500MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROMAZINE 100MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROMAZINE 10MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROMAZINE 25MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROMAZINE 25MG/ML AMP   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHLORPROMAZINE 50MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROMAZINE HCL 200MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROPAMIDE 100MG TABLET   2 Generic Tier $7.50$19.00None
CHLORPROPAMIDE 250MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
CHLORTHALIDONE 25MG TABLET (100 CT)   1 Value Generic Tier $2.50$5.00None
CHLORTHALIDONE 50MG TABLET (1000 CT)   1 Value Generic Tier $2.50$5.00None
CHLORZOXAZONE 250MG TABLET   1 Value Generic Tier $2.50$5.00None
CHLORZOXAZONE 500MG TABLET   1 Value Generic Tier $2.50$5.00None
CHOLESTYRAMINE LIGHT ORAL SUSP USP POWDER 4GM 210GM CAN   2 Generic Tier $7.50$19.00None
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 60 X 9GM SINGLE DOSE CRTN   2 Generic Tier $7.50$19.00None
CHOLESTYRAMINE POWDER FOR ORAL SUSPENSION USP 4GM 378GM CAN   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHORIONIC GONAD 10000U VIAL   2 Generic Tier $7.50$19.00P
CICLOPIROX 0.77% CREAM   2 Generic Tier $7.50$19.00None
CICLOPIROX 0.77% GEL   2 Generic Tier $7.50$19.00None
CICLOPIROX 0.77% TOPICAL SUSPENSION   2 Generic Tier $7.50$19.00None
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT   2 Generic Tier $7.50$19.00None
CILOSTAZOL 50MG TABLET (60 CT)   2 Generic Tier $7.50$19.00None
CILOSTAZOL TABLET 100MG (60 CT)   2 Generic Tier $7.50$19.00None
CILOXAN 0.3% OINTMENT   3 Preferred Brand Tier $39.00$98.00None
CIMETIDINE 150MG/ML VIAL   2 Generic Tier $7.50$19.00None
CIMETIDINE 200MG TABLET   1 Value Generic Tier $2.50$5.00None
CIMETIDINE HCL 300MG/5ML SOL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CIMETIDINE TABLET USP 300MG (1000 CT)   1 Value Generic Tier $2.50$5.00None
CIMETIDINE TABLET USP 400MG (1000 CT)   1 Value Generic Tier $2.50$5.00None
CIMETIDINE TABLET USP 800MG (30 CT)   1 Value Generic Tier $2.50$5.00None
CIMZIA KIT   5 Specialty Tier 33%N/AP
CIPRO (10%) SUS 500MG/5   3 Preferred Brand Tier $39.00$98.00None
CIPRO (5%) SUS 250MG/5   3 Preferred Brand Tier $39.00$98.00None
CIPRO HC OTIC SUSPENSION   4 Non-Preferred Brand Tier $98.00$270.00None
CIPRODEX OTIC SUSPENSION   4 Non-Preferred Brand Tier $98.00$270.00None
CIPROFLOXACIN 10MG/ML VIAL   2 Generic Tier $7.50$19.00None
CIPROFLOXACIN 250MG TABLET (100 CT)   1 Value Generic Tier $2.50$5.00None
CIPROFLOXACIN 500MG TABLET   1 Value Generic Tier $2.50$5.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CIPROFLOXACIN ER 1000MG TABLET (30 CT)   2 Generic Tier $7.50$19.00None
CIPROFLOXACIN ER 500MG TABLET (30 CT)   2 Generic Tier $7.50$19.00None
CIPROFLOXACIN HCL 0.3% DROPS   2 Generic Tier $7.50$19.00None
CIPROFLOXACIN HCL 100MG TABLET   1 Value Generic Tier $2.50$5.00None
CIPROFLOXACIN TABLETS 750MG 100 BOT   1 Value Generic Tier $2.50$5.00None
CISPLATIN INJECTION 1MG   2 Generic Tier $7.50$19.00None
CITALOPRAM HBR 20MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL   2 Generic Tier $7.50$19.00None
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT   2 Generic Tier $7.50$19.00None
CITOLOPRAM HBR 10MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CLADRIBINE 1MG/ML VIAL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLARAVIS 10MG CAPSULE   2 Generic Tier $7.50$19.00None
CLARAVIS 20MG CAPSULE   2 Generic Tier $7.50$19.00None
CLARAVIS 30MG CAPSULE   2 Generic Tier $7.50$19.00None
CLARAVIS 40MG CAPSULE   2 Generic Tier $7.50$19.00None
CLARITHROMYCIN 250MG TABLET   2 Generic Tier $7.50$19.00None
CLARITHROMYCIN 250MG/5ML. SUS. 100ML   2 Generic Tier $7.50$19.00None
CLARITHROMYCIN 500MG TABLET   2 Generic Tier $7.50$19.00None
CLARITHROMYCIN ER 500MG TABLET (60 CT)   2 Generic Tier $7.50$19.00None
CLARITHROMYCIN FOR ORAL SUSPENSION 125/5ML 125MG BOT   2 Generic Tier $7.50$19.00None
CLEMASTINE FUM 2.68MG TABLET   2 Generic Tier $7.50$19.00None
CLEMASTINE FUMARATE 0.67MG/5ML SYRUP   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLEOCIN 100MG VAGINAL OVULE   3 Preferred Brand Tier $39.00$98.00None
CLEOCIN HCL 75MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CLEOCIN PED SOL 75MG/5ML   3 Preferred Brand Tier $39.00$98.00None
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG   3 Preferred Brand Tier $39.00$98.00None
CLINDAMYCIN 150MG/ML ADDVAN   2 Generic Tier $7.50$19.00None
CLINDAMYCIN HCL 150MG CAPSULE   2 Generic Tier $7.50$19.00None
CLINDAMYCIN HCL 300MG CAPS   2 Generic Tier $7.50$19.00None
CLINDAMYCIN PHOSP 1% LOTION   2 Generic Tier $7.50$19.00None
CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL   2 Generic Tier $7.50$19.00None
CLINDAMYCIN PHOSPHATE 2% CREAM WITH APPLICATOR   2 Generic Tier $7.50$19.00None
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX   2 Generic Tier $7.50$19.00None
CLINIMIX 2.75%/5% INJECTION 1000ML BAG   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX 4.25/10 SOLUTION   2 Generic Tier $7.50$19.00P
CLINIMIX 4.25/20 SOLUTION   2 Generic Tier $7.50$19.00P
CLINIMIX 4.25/25 SOLUTION   2 Generic Tier $7.50$19.00P
CLINIMIX 4.25/5 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX 5/15 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX 5/20 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 2.75/10 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 2.75/5 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLINIMIX E 4.25/25 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 4.25/5 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 5/20 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 5/25 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 5/35 SOLUTION   3 Preferred Brand Tier $39.00$98.00P
CLINIMIX E 5%/15% INJECTION 2000ML BAG   3 Preferred Brand Tier $39.00$98.00P
CLINISOL 15% SOLUTION   2 Generic Tier $7.50$19.00P
CLOBETASOL 0.05% OINTMENT   2 Generic Tier $7.50$19.00None
CLOBETASOL 0.05% SOLUTION   2 Generic Tier $7.50$19.00None
CLOBETASOL E 0.05% CREAM   2 Generic Tier $7.50$19.00None
CLOBETASOL PROPIONATE 0.05% FOAM   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLOBETASOL PROPIONATE CRM 0.05% 15GM   2 Generic Tier $7.50$19.00None
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE   2 Generic Tier $7.50$19.00None
CLOMIPRAMINE HCL 25MG CAPSULE   2 Generic Tier $7.50$19.00None
CLOMIPRAMINE HCL 50MG CAPSULE   2 Generic Tier $7.50$19.00None
CLOMIPRAMINE HCL 75MG CAPSULE   2 Generic Tier $7.50$19.00None
CLONIDINE HCL 0.2MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CLONIDINE HCL TABLET 0.1MG (500 CT)   2 Generic Tier $7.50$19.00None
CLONIDINE HCL TABLET 0.3MG (100 CT)   2 Generic Tier $7.50$19.00None
CLOTRIMAZOLE 1% CREAM   2 Generic Tier $7.50$19.00None
CLOTRIMAZOLE 10MG TROCHE   2 Generic Tier $7.50$19.00None
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION   2 Generic Tier $7.50$19.00None
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CREAM USP .5MG-10GM 45GM TUBE   2 Generic Tier $7.50$19.00None
CLOZAPINE 200MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CLOZAPINE 25MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CLOZAPINE 50MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CLOZAPINE TABLETS 100MG 100 BOT   2 Generic Tier $7.50$19.00None
CO-GESIC 5/500 TABLET   2 Generic Tier $7.50$19.00None
COGENTIN 1MG/ML AMPUL   3 Preferred Brand Tier $39.00$98.00None
COLCHICINE TABLET USP 0.6MG (100 CT)   2 Generic Tier $7.50$19.00None
COLESTIPOL HCL 1G TABLET   2 Generic Tier $7.50$19.00None
COLESTIPOL HCL 5G GRANULES   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COLISTIMETHATE 150MG VIAL   2 Generic Tier $7.50$19.00P
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE   3 Preferred Brand Tier $39.00$98.00None
COLOCORT 100MG ENEMA   2 Generic Tier $7.50$19.00None
COMBIGAN 0.2%-0.5% DROPS   3 Preferred Brand Tier $39.00$98.00None
COMBIPATCH 0.05/0.14MG PTCH   3 Preferred Brand Tier $39.00$98.00None
COMBIPATCH 0.05/0.25MG PTCH   3 Preferred Brand Tier $39.00$98.00None
COMBIVENT INHALER   3 Preferred Brand Tier $39.00$98.00Q:30
/25Days
COMBIVIR TABLET   3 Preferred Brand Tier $39.00$98.00None
COMPRO 25MG SUPPOSITORY   2 Generic Tier $7.50$19.00None
COMTAN 200MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COMVAX VACCINE VIAL   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CONCERTA ER TABLETS 18MG 100 TABLETS BOT   4 Non-Preferred Brand Tier $98.00$270.00P
CONCERTA ER TABLETS 27MG 100 TABLETS BOT   4 Non-Preferred Brand Tier $98.00$270.00P
CONCERTA ER TABLETS 36MG 100 TABLETS BOT   4 Non-Preferred Brand Tier $98.00$270.00P
CONCERTA ER TABLETS 54MG 100 BOT   4 Non-Preferred Brand Tier $98.00$270.00P
CONDYLOX GEL 0.5% 3.5 GM CRTN   4 Non-Preferred Brand Tier $98.00$270.00None
CONSTULOSE 10GM/15ML SYRUP   2 Generic Tier $7.50$19.00None
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN   5 Specialty Tier 33%N/AP
CORDRAN 0.05% LOTION   4 Non-Preferred Brand Tier $98.00$270.00None
CORDRAN TAPE 4MCG/SQCM 1 X 80 X 3 CTR   4 Non-Preferred Brand Tier $98.00$270.00None
COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00None
COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00None
COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00None
CORMAX 0.05% CREAM   2 Generic Tier $7.50$19.00None
CORTIFOAM 10% FOAM   4 Non-Preferred Brand Tier $98.00$270.00None
CORTISONE ACETATE 25MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
CORTOMYCIN EAR SOLUTION   2 Generic Tier $7.50$19.00None
CORTOMYCIN EAR SUSPENSION   2 Generic Tier $7.50$19.00None
COSMEGEN 0.5MG VIAL   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 10MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 1MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 2.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COUMADIN 2MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 3MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 4MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 6MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COUMADIN 7.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
COZAAR 100MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
COZAAR 25MG TABLET (1000 CT)   4 Non-Preferred Brand Tier $98.00$270.00None
COZAAR 50MG TABLET 10000 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT   3 Preferred Brand Tier $39.00$98.00None
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT   3 Preferred Brand Tier $39.00$98.00None
CRESTOR 10MG TABLET   3 Preferred Brand Tier $39.00$98.00None
CRESTOR 20MG TABLET   3 Preferred Brand Tier $39.00$98.00None
CRESTOR 40MG TABLET   3 Preferred Brand Tier $39.00$98.00None
CRESTOR 5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
CRIXIVAN 100MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CRIXIVAN 200MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CRIXIVAN 333MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CRIXIVAN 400MG CAPSULE (120 CT)   3 Preferred Brand Tier $39.00$98.00None
CROMOLYN NEBULIZER SOLUTION   2 Generic Tier $7.50$19.00P Q:240
/25Days
CROMOLYN SODIUM 4% 40MG 10ML BOT   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CRYSELLE-28 TABLET 28 TABLET S   2 Generic Tier $7.50$19.00None
CUBICIN 500MG VIAL   5 Specialty Tier 33%N/ANone
CUPRIMINE 125MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CUPRIMINE CAPSULES 250MG (100 CT)   3 Preferred Brand Tier $39.00$98.00None
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
CYCLOPHOSPHAMIDE 1GM VIAL   3 Preferred Brand Tier $39.00$98.00None
CYCLOPHOSPHAMIDE 25MG TABLET   2 Generic Tier $7.50$19.00P
CYCLOPHOSPHAMIDE 500MG VIAL   3 Preferred Brand Tier $39.00$98.00None
CYCLOPHOSPHAMIDE 50MG TABLET   2 Generic Tier $7.50$19.00P
CYCLOSPORINE 100MG CAPSULE   2 Generic Tier $7.50$19.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYCLOSPORINE 25MG CAPSULE   2 Generic Tier $7.50$19.00P
CYCLOSPORINE 50MG/ML AMP   2 Generic Tier $7.50$19.00None
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT   2 Generic Tier $7.50$19.00P
CYKLOKAPRON 100MG/ML AMPUL   3 Preferred Brand Tier $39.00$98.00None
CYMBALTA 20MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CYMBALTA 60MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT)   3 Preferred Brand Tier $39.00$98.00None
CYPROHEPTADINE 4MG TABLET   2 Generic Tier $7.50$19.00None
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL   2 Generic Tier $7.50$19.00None
CYSTADANE POWDER FOR ORAL SOLUTION 180GM   3 Preferred Brand Tier $39.00$98.00None
CYSTAGON 150MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYSTAGON 50MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
CYTARABINE 20MG/ML VIAL   2 Generic Tier $7.50$19.00None
CYTARABINE 500MG VIAL   2 Generic Tier $7.50$19.00None
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD   2 Generic Tier $7.50$19.00None
CYTOVENE 500MG VIAL   3 Preferred Brand Tier $39.00$98.00None

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D CVS Caremark Complete (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2830) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2010 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.