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CVS Caremark Complete (PDP) (S5601-103-0)
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Tier 5 (183)
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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 T

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
TAMIFLU 30MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
TAMIFLU 45MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
TAMIFLU 75MG CAPSULE UD   3 Preferred Brand Tier $39.00$98.00None
TAMIFLU ORAL SUSPENSION   3 Preferred Brand Tier $39.00$98.00None
TAMOXIFEN CITRATE 20MG TABLET (30 CT)   2 Generic Tier $7.50$19.00None
TAMOXIFEN CITRATE TABLETS 10MG 180 BOT   2 Generic Tier $7.50$19.00None
TARCEVA 100MG TABLET   5 Specialty Tier 33%N/ANone
TARCEVA 150MG TABLET   5 Specialty Tier 33%N/ANone
TARCEVA 25MG TABLET   5 Specialty Tier 33%N/ANone
TARGRETIN 1% GEL 60GM TUBE   5 Specialty Tier 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TARGRETIN 75MG (100 CT)   5 Specialty Tier 33%N/ANone
TARKA 1/240MG TABLET SA   4 Non-Preferred Brand Tier $98.00$270.00None
TARKA 2/180MG TABLET SA   4 Non-Preferred Brand Tier $98.00$270.00None
TARKA 2/240MG TABLET SA   4 Non-Preferred Brand Tier $98.00$270.00None
TARKA 4/240MG TABLET SA   4 Non-Preferred Brand Tier $98.00$270.00None
TASIGNA 200MG CAPSULE 28 BLPK   5 Specialty Tier 33%N/ANone
TAXOTERE 80MG/2ML VIAL   5 Specialty Tier 33%N/ANone
TAZICEF 1GM VIAL   2 Generic Tier $7.50$19.00None
TAZICEF 2GM ADD-VANTAGE   2 Generic Tier $7.50$19.00None
TAZICEF 6GM/100ML VIAL   2 Generic Tier $7.50$19.00None
TAZTIA XT 120MG CAPSULE SA (500 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
TAZTIA XT 180MG CAPSULE SA (500 CT)   2 Generic Tier $7.50$19.00None
TAZTIA XT 240MG CAPSULE SA   2 Generic Tier $7.50$19.00None
TAZTIA XT 300MG CAPSULE SA (500 CT)   2 Generic Tier $7.50$19.00None
TAZTIA XT 360MG CAPSULE SA   2 Generic Tier $7.50$19.00None
TEGRETOL XR TABLETS 100MG 100 BOT   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA 150MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA 300MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA HCT 150-12.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA HCT 150MG-25MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA HCT 300-12.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TEKTURNA HCT 300MG-25MG 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
TERAZOSIN HCL 10MG CAPSULE   2 Generic Tier $7.50$19.00None
TERAZOSIN HCL 1MG CAPSULE   2 Generic Tier $7.50$19.00None
TERAZOSIN HCL 2MG CAPSULE   2 Generic Tier $7.50$19.00None
TERAZOSIN HCL 5MG CAPSULE   2 Generic Tier $7.50$19.00None
TERBINAFINE HCL 250MG TABLET   2 Generic Tier $7.50$19.00P
TERBUTALINE SULF 1MG/ML VL   2 Generic Tier $7.50$19.00None
TERBUTALINE SULF 2.5MG TABLET   2 Generic Tier $7.50$19.00None
TERBUTALINE SULFATE 5MG TABLET   2 Generic Tier $7.50$19.00None
TERCONAZOLE 0.4% CREAM WITH APPLICATOR   2 Generic Tier $7.50$19.00None
TERCONAZOLE 0.8% CREAM WITH APPLICATOR   2 Generic Tier $7.50$19.00None
TERCONAZOLE 80MG SUPPOSITORY VAGINAL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TESTIM 1%(50MG) GEL   3 Preferred Brand Tier $39.00$98.00P
TESTOSTERONE CYPIONATE INJECTION   2 Generic Tier $7.50$19.00None
TESTOSTERONE ENANTHATE INJECTION   2 Generic Tier $7.50$19.00None
TETANUS AND DIPHTHERIA TOXOIDS ADSORBED FOR ADULT USE 2 UNT/VIAL   3 Preferred Brand Tier $39.00$98.00P
TETANUS TOXOID ADSORBED VIAL 5LF   3 Preferred Brand Tier $39.00$98.00P
TETRACYCLINE 500MG CAPSULE   1 Value Generic Tier $2.50$5.00None
TETRACYCLINE HCL CAPSULES 250MG 100 (10 X 10) NS   1 Value Generic Tier $2.50$5.00None
TEV-TROPIN 5MG VIAL   5 Specialty Tier 33%N/AP
TEVETEN HCT TABLETS 600;25MG;MG 100 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
TEVETEN TABLETS 400MG 100 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
TEVETEN TABLETS 600;12.5MG;MG 100 BOT   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
TEVETEN TABLETS 600MG 100 BOT   4 Non-Preferred Brand Tier $98.00$270.00None
TEXACORT   2 Generic Tier $7.50$19.00None
TEXACORT 2.5% SOLUTION NON-ORAL   3 Preferred Brand Tier $39.00$98.00None
THALITONE 15MG TABLET   3 Preferred Brand Tier $39.00$98.00None
THALOMID 100MG CAPSULE 140 BOX   5 Specialty Tier 33%N/AP
THALOMID 150MG CAPSULE   5 Specialty Tier 33%N/AP
THALOMID 200MG CAPSULE 28 BLPK   5 Specialty Tier 33%N/AP
THALOMID 50MG CAPSULE 280 BOX   5 Specialty Tier 33%N/AP
THEO-24 100MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
THEO-24 200MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
THEO-24 300MG 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
THEO-24 400MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
THEOCHRON 100MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOCHRON 100MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOCHRON 200MG TABLET SA 100 EA   2 Generic Tier $7.50$19.00None
THEOCHRON TABLETS EXTENDED RELEASE 300MG 100 BOT   2 Generic Tier $7.50$19.00None
THEOPHYLLINE 200MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOPHYLLINE 300MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOPHYLLINE 400MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOPHYLLINE 600MG TABLET SA   2 Generic Tier $7.50$19.00None
THEOPHYLLINE ANHYDROUS ER TABLET 200MG (1000 CT)   2 Generic Tier $7.50$19.00None
THEOPHYLLINE TABLET ER 300MG (100 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
THEOPHYLLINE TABLET ER 450MG (100 CT)   2 Generic Tier $7.50$19.00None
THERMAZENE 50GM CREAM   2 Generic Tier $7.50$19.00None
THIOGUANINE TABLET LOID 40MG   3 Preferred Brand Tier $39.00$98.00None
THIOLA 100MG TABLET   3 Preferred Brand Tier $39.00$98.00None
THIORIDAZINE 100MG TABLET   2 Generic Tier $7.50$19.00None
THIORIDAZINE HCL 10MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
THIORIDAZINE HCL 25MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
THIORIDAZINE HCL 50MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
THIOTEPA POWDER FOR INJECTION 15MG/VIL 1 VIAL SINGLE DOSE CRTN   2 Generic Tier $7.50$19.00None
THIOTHIXENE 10MG CAPSULE   2 Generic Tier $7.50$19.00None
THIOTHIXENE 1MG CAPSULE (100 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
THIOTHIXENE 2MG CAPSULE   2 Generic Tier $7.50$19.00None
THIOTHIXENE 5MG CAPSULE   2 Generic Tier $7.50$19.00None
TICLOPIDINE HCL 250MG TABLET   2 Generic Tier $7.50$19.00None
TIKOSYN .125MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
TIKOSYN .250MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
TIKOSYN .5MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
TIMOLOL MAL SOL 0.25% OP 15ML BOT   1 Value Generic Tier $2.50$5.00None
TIMOLOL MAL SOL 0.5% OP 10ML BOT   1 Value Generic Tier $2.50$5.00None
TIMOLOL MALEATE 10MG TABLET   2 Generic Tier $7.50$19.00None
TIMOLOL MALEATE 20MG TABLET   2 Generic Tier $7.50$19.00None
TIMOLOL MALEATE 5MG 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
TINDAMAX 250MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TINDAMAX 500MG TABLET (60 CT)   3 Preferred Brand Tier $39.00$98.00None
TIS-U-SOL IRRIGATION SOLUTION   2 Generic Tier $7.50$19.00None
TIZANIDINE HCL 2MG TABLET (150 CT)   2 Generic Tier $7.50$19.00None
TIZANIDINE HCL 4MG TABLET 150 BOT   2 Generic Tier $7.50$19.00None
TOBRADEX EYE OINTMENT   4 Non-Preferred Brand Tier $98.00$270.00None
TOBRAMYCIN 10MG/ML VIAL   2 Generic Tier $7.50$19.00None
TOBRAMYCIN 40MG/ML VIAL   2 Generic Tier $7.50$19.00None
TOBRAMYCIN INHALATION SOLUTION   5 Specialty Tier 33%N/AP
TOBRAMYCIN OPHTHALMIC SOLUTION 0.3% 5ML BOT   1 Value Generic Tier $2.50$5.00None
TOBRAMYCIN-DEXAMETH OPTH SUSP   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOBRASOL 0.3% EYE DROPS   2 Generic Tier $7.50$19.00None
TOBREX 0.3% EYE OINTMENT   3 Preferred Brand Tier $39.00$98.00None
TOLAZAMIDE TABLETS 250MG 100 BOT   2 Generic Tier $7.50$19.00None
TOLAZAMIDE TABLETS 500MG 100 BOT   2 Generic Tier $7.50$19.00None
TOLBUTAMIDE 500MG TABLET   2 Generic Tier $7.50$19.00None
TOLMETIN SODIUM 200MG TABLET   2 Generic Tier $7.50$19.00None
TOLMETIN SODIUM 400MG CAPSULE   2 Generic Tier $7.50$19.00None
TOLMETIN SODIUM 600MG TABLET   2 Generic Tier $7.50$19.00None
TOPIRAMATE CAPSULES 25MG 60 CAPS BOT   2 Generic Tier $7.50$19.00None
TOPIRAMATE SPRINKLE CAPSULES 15MG 60 BOT   2 Generic Tier $7.50$19.00None
TOPIRAMATE TABLETS 100MG 1000 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
TOPIRAMATE TABLETS 200MG 1000 BOT   2 Generic Tier $7.50$19.00None
TOPIRAMATE TABLETS 25MG 1000 BOT   2 Generic Tier $7.50$19.00None
TOPIRAMATE TABLETS 50MG 1000 BOT   2 Generic Tier $7.50$19.00None
TOPOSAR INJECTION 20MG/ML 50ML VIAL MD CRTN   2 Generic Tier $7.50$19.00None
TORSEMIDE 100MG TABLET   2 Generic Tier $7.50$19.00None
TORSEMIDE 10MG TABLET   2 Generic Tier $7.50$19.00None
TORSEMIDE 20MG TABLET   2 Generic Tier $7.50$19.00None
TORSEMIDE 5MG TABLET   2 Generic Tier $7.50$19.00None
TPN ELECTROLYTES VIAL   2 Generic Tier $7.50$19.00None
TRACLEER 125MG TABLET   5 Specialty Tier 33%N/AP
TRACLEER 62.5MG TABLET   5 Specialty Tier 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRAMADOL HCL 50MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
TRAMADOL HCL-ACETAMINOPHEN 37.5-325MG TABLET (1000 CT)   2 Generic Tier $7.50$19.00None
TRANDOLAPRIL 1MG TABLET   2 Generic Tier $7.50$19.00None
TRANDOLAPRIL 2MG TABLET   2 Generic Tier $7.50$19.00None
TRANDOLAPRIL 4MG TABLET   2 Generic Tier $7.50$19.00None
TRANSDERM-SCOP 1.5MG 24 PKG   3 Preferred Brand Tier $39.00$98.00None
TRANYLCYPROMINE SULFATE 10MG TABLET   2 Generic Tier $7.50$19.00None
TRAVASOL 10% SOLUTION VIAFLEX   3 Preferred Brand Tier $39.00$98.00P
TRAVASOL 3.5%-ELECTROLYTES   2 Generic Tier $7.50$19.00P
TRAVASOL 5.5% SOLUTION/VIAFLEX   3 Preferred Brand Tier $39.00$98.00P
TRAVASOL 8.5%-ELECTROLYTES   2 Generic Tier $7.50$19.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRAVASOL 8.5%/DEXTROSE 10% QUICK MIX CONT   3 Preferred Brand Tier $39.00$98.00P
TRAVASOL 8.5%/DEXTROSE 20% QUICK MIX CONT   3 Preferred Brand Tier $39.00$98.00P
TRAVASOL 8.5%/DEXTROSE 50% QUICK MIX CONT   3 Preferred Brand Tier $39.00$98.00P
TRAVATAN Z 0.04MG DROPS 2.5ML BOT   4 Non-Preferred Brand Tier $98.00$270.00None
TRAZODONE 300MG TABLET   1 Value Generic Tier $2.50$5.00None
TRAZODONE HCL TABLET USP 100MG (500 CT)   1 Value Generic Tier $2.50$5.00None
TRAZODONE HCL TABLET USP 150MG (100 CT)   1 Value Generic Tier $2.50$5.00None
TRAZODONE HCL TABLET USP 50MG (500 CT)   1 Value Generic Tier $2.50$5.00None
TREANDA FOR INJECTION 100MG/VIAL   5 Specialty Tier 33%N/ANone
TRECATOR 250MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
TRELSTAR DEPOT 3.75MG SUSR   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
TRELSTAR LA 11.25MG VIAL   3 Preferred Brand Tier $39.00$98.00None
TRETINOIN 0.01% GEL 45GM TUBE   2 Generic Tier $7.50$19.00P
TRETINOIN 0.025% CREAM   2 Generic Tier $7.50$19.00P
TRETINOIN 0.025% GEL 45GM TUBE   2 Generic Tier $7.50$19.00P
TRETINOIN 0.025% GEL 45GM TUBE   2 Generic Tier $7.50$19.00P
TRETINOIN 0.05% CREAM 45GM TUBE   2 Generic Tier $7.50$19.00P
TRETINOIN 0.1% CREAM 45GM TUBE   2 Generic Tier $7.50$19.00P
TRETINOIN 10MG CAPSULE   5 Specialty Tier 33%N/ANone
TREZIX 16-356-30 CAPSULE   2 Generic Tier $7.50$19.00None
TRI-LEGEST FE 5-7-9-7 TABLET   2 Generic Tier $7.50$19.00None
TRI-SPRINTEC 7DAYSX3 28 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
TRIAMCINOLONE 0.1% OINTMENT   1 Value Generic Tier $2.50$5.00None
TRIAMCINOLONE 0.1% PASTE   2 Generic Tier $7.50$19.00None
TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 80GM TUBE   1 Value Generic Tier $2.50$5.00None
TRIAMCINOLONE ACETONIDE 0.1% LOTION 60ML BOTPL   2 Generic Tier $7.50$19.00None
TRIAMCINOLONE ACETONIDE 0.025% CREAM 80GM TUBE   1 Value Generic Tier $2.50$5.00None
TRIAMCINOLONE ACETONIDE 0.025% LOTION 2 FL OZ BOT   2 Generic Tier $7.50$19.00None
TRIAMCINOLONE ACETONIDE 0.05% CREAM 15GM TUBE   2 Generic Tier $7.50$19.00None
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE   2 Generic Tier $7.50$19.00None
TRIAMCINOLONE ACETONIDE 0.1% CREAM 80GM TUBE   1 Value Generic Tier $2.50$5.00None
TRIAMTERENE/HCTZ 25/37.5MG CAPSULES (100 CT)   1 Value Generic Tier $2.50$5.00None
TRIAMTERENE/HCTZ 37.5/25 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
TRIAMTERENE/HCTZ 50/25 CAPSULE   1 Value Generic Tier $2.50$5.00None
TRIAMTERENE/HCTZ 75/50 TABLET   1 Value Generic Tier $2.50$5.00None
TRICOR 145MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TRICOR 48MG TABLET   3 Preferred Brand Tier $39.00$98.00None
TRIDERM 0.1% CREAM   1 Value Generic Tier $2.50$5.00None
TRIDERM 0.1% OINTMENT   1 Value Generic Tier $2.50$5.00None
TRIFLUOPERAZINE 1MG TABLET   2 Generic Tier $7.50$19.00None
TRIFLUOPERAZINE HCL 2MG TABLET   2 Generic Tier $7.50$19.00None
TRIFLUOPERAZINE HCL 5MG TABLET   2 Generic Tier $7.50$19.00None
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML 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
TRIHEXYPHENIDYL HCL 5MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
TRIHEXYPHENIDYL HCL ELIXIR 5%/2 16 FLO BOT   2 Generic Tier $7.50$19.00None
TRIHEXYPHENIDYL HCL TABLET 2MG (1000 CT)   2 Generic Tier $7.50$19.00None
TRIHIBIT PRESERVATIVE FREE   3 Preferred Brand Tier $39.00$98.00None
TRILEPTAL 300MG/5ML SUSP   3 Preferred Brand Tier $39.00$98.00None
TRILYTE WITH FLAVOR PACKETS 5.72GM/11.2GM   2 Generic Tier $7.50$19.00None
TRIMETHOBENZAMIDE 100MG/ML   2 Generic Tier $7.50$19.00None
TRIMETHOBENZAMIDE HCL 300MG CAPSULE   2 Generic Tier $7.50$19.00None
TRIMETHOPRIM 100MG TABLET   2 Generic Tier $7.50$19.00None
TRIMIPRAMINE MALEATE 25MG CAPSULE   2 Generic Tier $7.50$19.00None
TRIMIPRAMINE MALEATE 50MG CAPSULE   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIMOX CAP 500MG   2 Generic Tier $7.50$19.00None
TRINESSA 28 TABLETS 0.180;0.35MG;MG   2 Generic Tier $7.50$19.00None
TRIPEDIA PRESERVATIVE FREE 6.7;23.4; UNT/.5 ML;   3 Preferred Brand Tier $39.00$98.00None
TRIPLE THERAPY PREVPAC KIT 30;500;500MG;MG;MG; 14 PKGCOM   3 Preferred Brand Tier $39.00$98.00None
TRISENOX 10MG/10ML AMPULE   3 Preferred Brand Tier $39.00$98.00None
TRIVORA-28 TABLET   2 Generic Tier $7.50$19.00None
TRIZIVIR TABLET   3 Preferred Brand Tier $39.00$98.00None
TROPHAMINE INJECTION SOLUTION   3 Preferred Brand Tier $39.00$98.00P
TROPHAMINE INJECTION SOLUTION 6%   3 Preferred Brand Tier $39.00$98.00P
TROPICACYL SOL 0.5% OP   2 Generic Tier $7.50$19.00None
TROPICACYL SOL 1% OP   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TROPICAMIDE 0.5% EYE DROPS   2 Generic Tier $7.50$19.00None
TROPICAMIDE 1% EYE DROPS   2 Generic Tier $7.50$19.00None
TRUVADA TABLET   3 Preferred Brand Tier $39.00$98.00None
TWINRIX TF PF VACCINE 720UNT/20ML 10 X 1ML VIALSD   3 Preferred Brand Tier $39.00$98.00None
TYGACIL 50MG VIAL 10 VILSU BOX   5 Specialty Tier 33%N/ANone
TYKERB 250MG TABLET   5 Specialty Tier 33%N/ANone
TYPHIM VI 25MCG/0.5ML VIAL   3 Preferred Brand Tier $39.00$98.00None
TYZEKA 600MG TABLET (30 CT)   3 Preferred Brand Tier $39.00$98.00None
TYZINE 0.1% NOSE DROPS   3 Preferred Brand Tier $39.00$98.00None
TYZINE PEDIATRIC 0.05% DROP   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 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 wit 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 which tier the drug is in. 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.