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2010 Medicare Part D Plan (PDP Only) Formulary Browser

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AARP MedicareRx Preferred (PDP) (S5820-031-0)
Tier 1 (1691)
Tier 2 (794)
Tier 3 (2052)
Tier 4 (379)

Requires Prior Authorization:
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Uses Step Therapy:
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2010 Medicare Part D Plan Formulary Information
AARP MedicareRx Preferred (PDP) (S5820-031-0)
Benefit Details  
The AARP MedicareRx Preferred (PDP) (S5820-031-0)
Formulary Drugs Starting with the Letter O

in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter O

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
OCELLA TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG   4 Tier 4 Specialty 33%33%P
OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD   4 Tier 4 Specialty 33%33%P
OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP   4 Tier 4 Specialty 33%33%P
OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP   4 Tier 4 Specialty 33%33%P
OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD   4 Tier 4 Specialty 33%33%P
OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00P
OCUFEN 0.03% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OCUFLOX 0.3% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OCUSULF-10 EYE DROPS   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OFLOXACIN 0.3% DROPS   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OFLOXACIN 200MG TABLET (50 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OFLOXACIN 300MG TABLET (50 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OFLOXACIN 400MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OGEN 0.625MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OGEN 1.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OGEN 2.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OGESTREL TABLET 0.05MG/0.5MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OLOPATADINE HCL 0.6% SPRAY SOLUTION NASAL SPRAY   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:31
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OLUX-E 0.05% FOAM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:31
/31Days
OMEPRAZOLE 20MG CAPSULE DELAYED RELEASE   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:124
/31Days
OMEPRAZOLE DR CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:31
/31Days
OMNARIS 50MCG SPRAY NON-AEROSOL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:13
/31Days
OMNICEF 125MG/5ML SUSP   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OMNICEF 300MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OMNICEF SUS 250/5ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OMNIPRED OPHTHALMIC SUSPENSION 1% 10 ML BOTPL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM   4 Tier 4 Specialty 33%33%P
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG   4 Tier 4 Specialty 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG   4 Tier 4 Specialty 33%33%P
ONCASPAR 750UNIT/ML VIAL   4 Tier 4 Specialty 33%33%None
ONDANSETRON HCL 24MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00P Q:3
/3Days
ONDANSETRON HCL 4MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00P Q:9
/3Days
ONDANSETRON HCL 4MG/5ML SOLUTION ORAL   2 Tier 2 Generic Preferred Brand $42.00$111.00P Q:100
/3Days
ONDANSETRON HCL 8MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00P Q:9
/3Days
ONDANSETRON INJECTION 2MG 5X2ML VIAL   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ONDANSETRON ODT 4MG TABLET (30 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00P Q:9
/3Days
ONDANSETRON ODT 8MG (10 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00P Q:9
/3Days
ONTAK INJECTION 300MCG/2ML VIALSU   4 Tier 4 Specialty 33%33%None
ONXOL PACLITAXEL INJECTION 6MG/ML 5 ML VIALGL   4 Tier 4 Specialty 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OPANA 10MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:6
/1Days
OPANA 5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:6
/1Days
OPANA ER 10MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 15MG TABLET SR 12HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 20MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 30MG TABLET SR 12HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 40MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPANA ER 7.5MG TABLET SR 12HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
OPTIPRANOLOL 0.3% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OPTIVAR 0.05% DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ORACEA CAPSULES 40MG 30 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES   4 Tier 4 Specialty 33%33%P Q:4
/1Days
ORAMORPH SR 100MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:6
/1Days
ORAMORPH SR 15MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
ORAMORPH SR 30MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
ORAMORPH SR 60MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00Q:4
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ORAP 1MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ORAP 2MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ORAPRED ODT 10MG TABLET 48 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORAPRED ODT TABLETS 15MG 14 PKG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORAPRED ODT TABLETS 30MG 14 CARD PKG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORAPRED SOLUTION 15MG/5ML 20 ML BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORENCIA 250MG VIAL   4 Tier 4 Specialty 33%33%P
ORFADIN 10MG CAPSULE   4 Tier 4 Specialty 33%33%None
ORFADIN 2MG CAPSULE   4 Tier 4 Specialty 33%33%None
ORFADIN 5MG CAPSULE   4 Tier 4 Specialty 33%33%None
ORPHENADRINE CITRATE ER TABLET 100MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ORPHENADRINE CITRATE INJECTION 3030MG/ML 10ML VIAL   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ORPHENADRINE COMP FORTE TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ORPHENADRINE COMPOUND 25-385-30 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ORTHO EVRA DIS WEEK .75MG / 6MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO MICRON TABLET DIALPAK   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO NOVUM 7 7 7 28 TABLETS 0.035;1;0.MG;MG;MG 6 X 28 DLPK   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO TRI-CYCLEN LO TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO-CEPT 28 DAY TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO-CYCLEN 28 TABLET 28 X 6 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
ORTHO-EST 0.625 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ORTHO-EST 1.25 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ORTHOCLONE OKT-3 5MG/5ML   4 Tier 4 Specialty 33%33%P
OSMOPREP TABLET 1.5GM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OVCON-35 28 TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OVCON-50 28 TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OVIDE 0.5% LOTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXACILLIN 1GM/50ML INJ   4 Tier 4 Specialty 33%33%None
OXACILLIN 2GM/50ML INJ   4 Tier 4 Specialty 33%33%None
OXACILLIN FOR INJECTION 1 GM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXACILLIN INJECTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXANDRIN 10MG TABLET   4 Tier 4 Specialty 33%33%P
OXANDRIN 2.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OXANDROLONE 10MG TABLET   4 Tier 4 Specialty 33%33%P
OXANDROLONE 2.5MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00P
OXAPROZIN 600MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXCARBAZEPINE 150MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXCARBAZEPINE 300MG TABLET 500 NCRC BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXCARBAZEPINE 600MG TABLET 500 NCRC BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXISTAT 1% CREAM 30GM TUBE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXISTAT 1% LOTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXSORALEN 1% LOTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $76.00$213.00None
OXSORALEN-ULTRA 10MG CAP   4 Tier 4 Specialty 33%33%None
OXYBUTYNIN 5MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:62
/31Days
OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:31
/31Days
OXYBUTYNIN CHLORIDE SYRUP USP 5MG/5ML 5 ML UNIT DOSE CUP   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00Q:62
/31Days
OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE AND ACETAMINOPHEN CAPSULES 500;5MG;MG 500 BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HCL 30MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HCL 5MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HCL ER TABLETS 10MG 100 BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCODONE HCL ER TABLETS 20MG 100 BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OXYCODONE HCL ER TABLETS 80MG 100 BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:6
/1Days
OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HCL-IBUPROFEN 400MG-5MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HYDROCHLORIDE AND ACETAMINOPHEN TABLETS 650;10MG;MG 100 BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCODONE/ASA 4.88/325 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
OXYCONTIN 10MG TABLET SA   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCONTIN 15MG TABLET SR 12HR   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCONTIN 20MG TABLET SA   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
OXYCONTIN 30MG TABLET SR 12HR   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCONTIN 40MG TABLET SA   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCONTIN 60MG TABLET SR 12HR   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:4
/1Days
OXYCONTIN 80MG TABLET SA   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:6
/1Days
OXYTROL 3.9MG/24HR PATCH   2 Tier 2 Generic Preferred Brand $42.00$111.00Q:10
/31Days

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D AARP MedicareRx Preferred (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.