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2010 Medicare Part D Plan (PDP Only) Formulary Browser

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Blue Cross MedicareRx Plus (PDP) (S5596-034-0)
Tier 1 (1670)
Tier 2 (594)
Tier 3 (82)
Tier 4 (608)
Tier 5 (364)
Requires Prior Authorization:
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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
Blue Cross MedicareRx Plus (PDP) (S5596-034-0)
Benefit Details  
The Blue Cross MedicareRx Plus (PDP) (S5596-034-0)
Formulary Drugs Starting with the Letter P

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
PACERONE 100MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PACERONE 200MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PACERONE 300MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PALGIC 4MG/5ML LIQUID   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PALGIC TABLETS 4GM 100 CTR   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PAMIDRONATE 60MG/10ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PANCREASE MT 10 CAPSULE EC   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PANCREASE MT 16 CAPSULE EC   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCREASE MT 20 CAPSULE EC   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCREASE MT 4 CAPSULE EC   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCRECARB MS-16 52-16-52 CAPSULE DELAYED RELEASE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCRECARB MS-4 CAPSULE EC   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCRECARB MS-8 PANCRELIPASE CAPSULES 40000UNT (100 CT)   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PANCRELIPASE 16-48-48 CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PANCRELIPASE TABLET 8000;30000 MG;   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PANCRON 10 CAPSULE EC   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PANCRON 20 CAPSULE SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PANRETIN 0.1% GEL 60GM TUBE   5 Tier 5 Specialty Drugs 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PARCAINE 0.5% DROPS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PAROMOMYCIN 250MG CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PAROXETINE 40MG TABLET (500 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:60
/30Days
PAROXETINE FILM COATED 20MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PAROXETINE HCL 10MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PAROXETINE HCL 10MG/5ML SUSPENSION ORAL   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:1200
/30Days
PAROXETINE HCL TABLET 24 12.5MG   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PAROXETINE HCL TABLET 24 25MG   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:90
/30Days
PAROXETINE TABLETS 30MG 90 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:60
/30Days
PASER GRANULES 4GM PACKET   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50None
PATADAY 0.2% DROPS   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50Q:5
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PATANOL 0.1% EYE DROPS   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50Q:5
/30Days
PEDI-DRI TOPICAL POWDER   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PEDIARIX SOLUTION INJECTION 25-25-10 10 X .5ML VIAL   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PEDVAXHIB VACCINE VIAL   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PEG 3350/ELECTROLYTE 240-22.72G SOLUTION RECONSTITUTED ORAL   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PEG-INTRON 100MCG KIT   5 Tier 5 Specialty Drugs 33%N/AP
PEG-INTRON REDIPEN 120MCG   5 Tier 5 Specialty Drugs 33%N/AP
PEG-INTRON REDIPEN 150MCG   5 Tier 5 Specialty Drugs 33%N/AP
PEG-INTRON REDIPEN 50MCG   5 Tier 5 Specialty Drugs 33%N/AP
PEG-INTRON REDIPEN 80MCG   5 Tier 5 Specialty Drugs 33%N/AP
PEG-INTRON REDIPEN 80MCG 4PK   5 Tier 5 Specialty Drugs 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PEG-INTRON REDIPEN PAK 4   5 Tier 5 Specialty Drugs 33%N/AP
PEGANONE 250MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PEGASYS 180MCG/0.5ML CONV.PK   5 Tier 5 Specialty Drugs 33%N/AP
PEGINTRON REDIPEN 150MCG 4PK   5 Tier 5 Specialty Drugs 33%N/AP
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN G POTASSIUM FOR INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN G POTASSIUM FOR INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN G PROCAINE 1200000UNT 2ML CTG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN G SODIUM FOR INJECTION 5000000UNT 1 VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PENICILLIN V POTASSIUM 250MG TABLET (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PENICILLIN V POTASSIUM 250MG/5ML LIQUID   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PENICILLIN V POTASSIUM 500MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PENICILLIN V POTASSIUM FOR ORAL SOLUTION CONCENTRATE 125MG 200ML BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PENTAM 300 INJ 300MG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PENTASA 250MG CAPSULE SA   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PENTASA 500MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PENTAZOCINE/ACETAMIN TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:180
/30Days
PENTAZOCINE/NALOXONE TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:180
/30Days
PENTOPAK 400MG TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PENTOSTATIN FOR INJECTION 10MG/VIAL   5 Tier 5 Specialty Drugs 33%N/ANone
PENTOXIFYLLINE 400MG TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PENTOXIL 400MG TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PEPCID PREMX SOL 20MG/50M   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PERFOROMIST 20MCG/2ML VIAL NEBULIZER   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:120
/30Days
PERIOGARD 0.12% ORAL RINSE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PERMETHRIN 5% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PERPHENAZINE TABLETS 16MG 100 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PERPHENAZINE TABLETS 4MG 100 BOXUD   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PERPHENAZINE TABLETS 8MG 100 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PERPHENAZINE TABLETS USP 2MG 100 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PFIZERPEN 20MMU VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PFIZERPEN 5MMU VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PHENADOZ 12.5MG SUPPOSITORY   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PHENADOZ 25MG SUPPOSITORY   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PHENERGAN 25MG/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PHENERGAN 50MG/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PHENYTEK 200MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PHENYTEK 300MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PHENYTOIN SODIUM INJECTION 50MG 25 X 2ML AMP   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PHOSLO 667MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PHOTOFRIN 75MG VIAL   5 Tier 5 Specialty Drugs 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PHYSIOLYTE SOLUTION FOR IRRIGATION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PHYSIOSOL IRRIGATION SOL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PILOCARPINE HCL 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PILOCARPINE HCL 7.5MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PILOPINE HS 4% EYE GEL   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50None
PINDOLOL 10MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PINDOLOL 5MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PIPERACILLIN 3GM VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PIPERACILLIN 40GM BULK VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PIROXICAM 10MG CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PIROXICAM 20MG CAPSULE (500 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PLASMA-LYTE 148 IV SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLASMA-LYTE 148/DEXTROSE 5%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLASMA-LYTE 56 INJECTION 32;128 MG/100ML;   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLASMA-LYTE 56/DEXTROSE 5%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLASMA-LYTE INJ-R   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PLATINOL AQ INJECTION SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PLAVIX 75MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PLAVIX TABLETS 300MG   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PODOFILOX 0.5% TOPICAL TUBEX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POLY-DEX 0.1% SUSPENSION DROPS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POLY-DEX 3.5-10K-.1 OINTMENT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POLYCIN-B 500-10KU/G OINTMENT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POLYGAM S/D 10GM VL W/DILUENT   5 Tier 5 Specialty Drugs 33%N/AP
POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1%   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POLYMYXIN B SULFATE VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PORTIA 0.15-0.03 TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:28
/28Days
POTASSIUM CHLORIDE 0.075%/D5W/SODIUM CHLORIDE 0.2%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.3%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.45%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.2%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 10MEQ TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CHLORIDE 10MEQ/100ML SOL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 10MEQ/50ML SOL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 20MEQ IN D5W LACT RNG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 20MEQ TABLET SR PARTICLES/CRYSTALS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CHLORIDE 20MEQ/50ML SOL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 20MEQ/NS 1000ML IV SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 30MEQ/100ML SOL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 40MEQ IN D5W LACT RNG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CHLORIDE 40MEQ IN D5W/NACL 0.9%   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE 8MEQ TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CHLORIDE ER CAPSULES 10MEQ   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CHLORIDE ER CPCR 8MEQ   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CHLORIDE FOR INJECTION CONCENTRATE   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN 10% DEXTROSE AND NACL SOLUTION FOR INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CHLORIDE IN 5% DEXTROSE INJECTION 40 12 X 1000ML CTR   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN DEXTROSE AND SODIUM CHLORIDE INJECTION 5-30-.225 12 X 1000ML CTR   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN DEXTROSE INJECTION 5GM/75MG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION 0.15%-0.9% 12 X 1000ML BAG   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
POTASSIUM CITRATE 10MEQ TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
POTASSIUM CITRATE 5MEQ TABLET SA   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PRAVASTATIN SODIUM 20MG TABLET 500 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PRAVASTATIN SODIUM 40MG TABLET (500 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PRAVASTATIN SODIUM 80MG TABLET (90 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PRAVASTATIN SODIUM TABLETS 10MG 90 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:30
/30Days
PRAZOSIN 5MG CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRAZOSIN HCL 1MG CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PRAZOSIN HCL 2MG CAPSULE   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNICARBATE 0.1% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNICARBATE 0.1% OINTMENT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISOLONE 5MG/5ML TUBEX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISOLONE SOD 1% EYE DROP   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 1MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 2.5MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREDNISONE 20MG TABLET (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 50MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 5MG/5ML SOLUTION   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREDNISONE 5MG/ML SOLUTION   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREGNYL INJ 10000UNT   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PREMARIN 0.3MG (100 CT)   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMARIN 0.45MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMARIN 0.625MG (100 CT)   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMARIN 0.9MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMARIN 1.25MG (100 CT)   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREMARIN 25MG VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PREMARIN VAGINAL CREAM /APPL   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50Q:86
/30Days
PREMASOL 10% IV SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PREMASOL 6% IV SOLUTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PREMPHASE 0.625/5MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMPRO 0.3MG/1.5MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMPRO 0.45/1.5MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMPRO 0.625/2.5MG TABLET DIALPK   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PREMPRO 0.625/5MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PRENATABS OBN TABLETS 200;1;150;MG;MG;MCG; 90 BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREVACID CAPSULES EXTENDED RELEASE 15MG 100 BOXUD   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREVACID CAPSULES EXTENDED RELEASE 30MG 100 BOXUD   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50Q:30
/30Days
PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50Q:30
/30Days
PREVACID SOLUTAB TABLETS DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50Q:30
/30Days
PREVALITE POW 4GM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREVALITE POW 4GM PK   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PREVIFEM TABLETS .035;.25MG;MG 28 BLPK   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:28
/28Days
PREZISTA TABLET 600MG   5 Tier 5 Specialty Drugs 33%N/ANone
PREZISTA TABLET 75MG   5 Tier 5 Specialty Drugs 33%N/ANone
PREZISTA TABLETS 400MG 60 TABLETS BOT   5 Tier 5 Specialty Drugs 33%N/ANone
PRIFTIN 150MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PRIMAQUINE 26.3MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRIMAXIN I.M. 500MG VIAL   5 Tier 5 Specialty Drugs 33%N/ANone
PRIMAXIN IV 250MG VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PRIMAXIN IV INJ 500MG   5 Tier 5 Specialty Drugs 33%N/ANone
PRIMIDONE 250MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PRIMIDONE 50MG TABLET (500 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PRISTIQ 100MG TABLET SR 24HR   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:30
/30Days
PRISTIQ 50MG TABLET SR 24HR   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:30
/30Days
PROAIR HFA 90MCG HFA AEROSOL WITH ADAPTER   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50Q:27
/30Days
PROBENECID 500MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROBENECID/COLCHICINE TABLET S   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCAINAMIDE 100MG/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROCAINAMIDE 500MG/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PROCALAMINE INJECTION 210MG-290MG-26MG 6 X 1000ML BOT   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCRIT 10000U/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROCRIT 3000U/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROCRIT 40000U/ML VIAL PR   5 Tier 5 Specialty Drugs 33%N/AP
PROCRIT 4000U/ML VIAL 25 X 1ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY   5 Tier 5 Specialty Drugs 33%N/AP
PROCTO-PAK 1% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCTOCREAM-HC 2.5% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCTOSOL-HC 2.5% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROCTOZONE-HC 2.5% CREAM   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROGLYCEM 50MG/ML ORAL SUSP   5 Tier 5 Specialty Drugs 33%N/ANone
PROGRAF 0.5MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50P
PROGRAF 1MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50P
PROGRAF 5MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50P
PROGRAF 5MG/ML AMPULE   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROLASTIN 500MG VIAL   5 Tier 5 Specialty Drugs 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROLEUKIN 22 MILLION UNITS VL   5 Tier 5 Specialty Drugs 33%N/ANone
PROMACTA TABLETS   5 Tier 5 Specialty Drugs 33%N/AP
PROMACTA TABLETS 25 MG   5 Tier 5 Specialty Drugs 33%N/AP
PROMETHAZINE 50MG/ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PROMETHAZINE HCL 12.5MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHAZINE HCL 25MG TABLET (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHAZINE HCL 50MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHAZINE HCL 6.25MG/5ML SYRUP   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHAZINE HCL INJECTION 25MG 10 X 1ML VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROMETHAZINE VC PLAIN 6.25-5MG 16 FL OZ BOT   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHEGAN 25MG SUPP   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETHEGAN 50MG SUPPOS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROMETRIUM 100MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PROMETRIUM 200MG CAPSULE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PROPAFENONE HCL 150MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPAFENONE HCL 225MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPAFENONE HCL 300MG TABLET (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPANTHELINE 15MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPARACAINE 0.5% EYE DROPS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPOXY-N/APAP 100-500MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:240
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROPOXY-N/APAP 100-650 TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:180
/30Days
PROPOXY-N/APAP 50-325 TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:360
/30Days
PROPOXYPHENE HCL AND ACETAMINOPHEN TABLET 650/65MG (500 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:210
/30Days
PROPOXYPHENE HCL CAPSULES 65MG (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL 20MG/5ML TUBEX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL 40MG/5ML TUBEX   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL 60MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL 80MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL 20MG TABLET (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL CAPSULES ER 120MG (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL CAPSULES ER 160MG (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROPRANOLOL HCL CAPSULES ER 60MG (100 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL CAPSULES ER 80MG (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL INJECTION 1MG 10 PKG OF 10 CRTN   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
PROPRANOLOL HCL TABLET USP 10MG (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL HCL TABLET USP 40MG (1000 CT)   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL/HCTZ 40/25 TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPRANOLOL/HCTZ 80/25 TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROPYLTHIOURACIL 50MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROQUAD VIAL   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50None
PROSOL 20% INJECTION   4 Tier 4 Non-Specialty Injectable Drugs 33%33%P
PROTONIX IV 40MG VIAL   4 Tier 4 Non-Specialty Injectable Drugs 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROTRIPTYLINE HYDROCHLORIDE TABLETS   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG   1 Tier 1 Preferred Generic Drugs $7.00$10.50Q:120
/30Days
PROVENTIL HFA INHALER 90MCG AE   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50Q:21
/30Days
PROVIGIL 100MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50P Q:30
/30Days
PROVIGIL 200MG TABLET   2 Tier 2 Preferred Brand Certain Generic Drugs $43.00$107.50P Q:60
/30Days
PULMICORT .25MG/2ML RESPULE   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:120
/30Days
PULMICORT 0.5MG/2ML RESPULE   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:120
/30Days
PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION   3 Tier 3 Non-Preferred Brand Certain Generic Drugs $85.00$212.50P Q:120
/30Days
PULMOZYME 1MG/ML AMPUL   5 Tier 5 Specialty Drugs 33%N/AP
PYRAZINAMIDE 500MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None
PYRIDOSTIGMINE BROMIDE 60MG TABLET   1 Tier 1 Preferred Generic Drugs $7.00$10.50None

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D Blue Cross MedicareRx Plus (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.