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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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Yes No Show either
Uses Step Therapy:
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Has Quantity Limits:
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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 A

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG   2 Generic Tier $7.50$19.00None
A-HYDROCORT 100MG VIAL   2 Generic Tier $7.50$19.00None
A-METHAPRED 40MG UNIVIAL   2 Generic Tier $7.50$19.00None
ABILIFY 10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 15MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 1MG/ML SOLUTION   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 20MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 2MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 30MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY 5MG TABLET (OTSUKA)   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
ABILIFY DISCMELT 10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY DISCMELT 15MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ABILIFY INJ 9.75MG   4 Non-Preferred Brand Tier $98.00$270.00None
ACARBOSE 100MG TABLET S   2 Generic Tier $7.50$19.00None
ACARBOSE 25MG TABLET S   2 Generic Tier $7.50$19.00None
ACARBOSE 50MG TABLET S   2 Generic Tier $7.50$19.00None
ACCOLATE 10MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACCOLATE 20MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACEBUTOLOL 200MG CAPSULE   2 Generic Tier $7.50$19.00None
ACEBUTOLOL 400MG CAPSULE   2 Generic Tier $7.50$19.00None
ACEON 2MG 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
ACEON 4MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACEON 8MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD   2 Generic Tier $7.50$19.00None
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)   2 Generic Tier $7.50$19.00None
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT)   2 Generic Tier $7.50$19.00None
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)   2 Generic Tier $7.50$19.00None
ACETASOL HC OTIC SOLUTION   2 Generic Tier $7.50$19.00None
ACETASOL HC SOLUTION 10ML 10 ML BOT   2 Generic Tier $7.50$19.00None
ACETAZOLAMIDE 125MG TABLET   2 Generic Tier $7.50$19.00None
ACETAZOLAMIDE 250MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 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
ACETAZOLAMIDE SOD 500MG VL   2 Generic Tier $7.50$19.00None
ACETIC ACID 2% SOLUTION NON-ORAL   2 Generic Tier $7.50$19.00None
ACETYLCYSTEINE 10% VIAL   2 Generic Tier $7.50$19.00P
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN   2 Generic Tier $7.50$19.00P
ACTHIB VACCINE VIAL 10-24UNT/5ML   3 Preferred Brand Tier $39.00$98.00None
ACTICIN 5% CREAM   2 Generic Tier $7.50$19.00None
ACTIMMUNE SOLUTION FOR INJECTION 100MCG   5 Specialty Tier 33%N/ANone
ACTONEL 150MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACTONEL 30MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACTONEL 35MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACTONEL 5MG 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
ACTONEL 75MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ACTOPLUS MET 15MG/500MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ACTOPLUS MET 15MG/850MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ACTOS 15MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ACTOS 30MG TABLET (500 CT)   3 Preferred Brand Tier $39.00$98.00None
ACTOS 45MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ACULAR 0.5% EYE DROPS   4 Non-Preferred Brand Tier $98.00$270.00None
ACULAR LS 0.4% OPHTH SOL   4 Non-Preferred Brand Tier $98.00$270.00None
ACYCLOVIR 200MG CAPSULE (1000 CT)   2 Generic Tier $7.50$19.00None
ACYCLOVIR 200MG/5ML SUSP   2 Generic Tier $7.50$19.00None
ACYCLOVIR 400MG TABLET (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
ACYCLOVIR SODIUM 500MG VIAL   2 Generic Tier $7.50$19.00None
ACYCLOVIR TABLET USP 800MG (100 CT)   2 Generic Tier $7.50$19.00None
ADACEL VIAL 2UNT/5UNT   3 Preferred Brand Tier $39.00$98.00None
ADAGEN 250U/ML VIAL   5 Specialty Tier 33%N/ANone
ADVAIR DISKU MIS 100/50   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
ADVAIR DISKU MIS 250/50   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
ADVAIR DISKU MIS 500/50   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   3 Preferred Brand Tier $39.00$98.00Q:12
/25Days
ADVAIR HFA INHALER 230;21MCG;MCG   3 Preferred Brand Tier $39.00$98.00Q:12
/25Days
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   3 Preferred Brand Tier $39.00$98.00Q:12
/25Days
ADVICOR ER 20-750MG TABLET (90 CT)   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
ADVICOR EXTENDED RELEASE TABLETS 20;1000MG;MG 90 BOTPL   4 Non-Preferred Brand Tier $98.00$270.00None
ADVICOR EXTENDED RELEASE TABLETS 20;500MG;MG 90 BOTPL   4 Non-Preferred Brand Tier $98.00$270.00None
ADVICOR EXTENDED RELEASE TABLETS 40;1000MG;MG 90 BOTPL   4 Non-Preferred Brand Tier $98.00$270.00None
AFEDITAB CR 30MG TABLET SA   2 Generic Tier $7.50$19.00None
AFEDITAB CR 60MG TABLET SA   2 Generic Tier $7.50$19.00None
AGGRENOX 25-200MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
AK-CON 0.1% EYE DROPS   2 Generic Tier $7.50$19.00None
AK-POLY-BAC EYE OINTMENT 500UNT/1000UNT   2 Generic Tier $7.50$19.00None
AKTOB 0.3% EYE DROPS   2 Generic Tier $7.50$19.00None
ALA-CORT 1% CREAM   2 Generic Tier $7.50$19.00None
ALA-CORT 1% LOTION   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALBENZA 200MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER   2 Generic Tier $7.50$19.00P Q:300
/25Days
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   2 Generic Tier $7.50$19.00P Q:300
/25Days
ALBUTEROL SULFATE 2.5MG/3ML VIAL NEBULIZER   2 Generic Tier $7.50$19.00P Q:300
/25Days
ALBUTEROL SULFATE 4MG TABLET SR 12HR   2 Generic Tier $7.50$19.00None
ALBUTEROL SULFATE 8MG TABLET SR 12HR   2 Generic Tier $7.50$19.00None
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   2 Generic Tier $7.50$19.00P Q:60
/25Days
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   2 Generic Tier $7.50$19.00None
ALBUTEROL SULFATE TABLET 2MG (500 CT)   2 Generic Tier $7.50$19.00None
ALBUTEROL TABLET 4MG (500 CT)   2 Generic Tier $7.50$19.00None
ALCLOMETASONE DIPROPIONATE 0.05% CREAM   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT   2 Generic Tier $7.50$19.00None
ALCOHOL 5%/DEXTROSE 5%   2 Generic Tier $7.50$19.00None
ALDACTAZIDE 50/50 TABLET   3 Preferred Brand Tier $39.00$98.00None
ALDARA IMIQUIMOD CREAM 5% 24 PKT X 250 MG CRTN   4 Non-Preferred Brand Tier $98.00$270.00None
ALDURAZYME 2.9MG/5ML VIAL   5 Specialty Tier 33%N/ANone
ALENDRONATE SODIUM 10MG TABLET   2 Generic Tier $7.50$19.00None
ALENDRONATE SODIUM 40MG TABLET   2 Generic Tier $7.50$19.00None
ALENDRONATE SODIUM 5MG TABLET   2 Generic Tier $7.50$19.00None
ALENDRONATE SODIUM 70MG TABLET 4 BLPK   2 Generic Tier $7.50$19.00None
ALENDRONATE SODIUM TABLET 35MG 20 CRTN   2 Generic Tier $7.50$19.00None
ALIMTA 500MG VIAL   5 Specialty Tier 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALINIA 100MG/5ML SUSPENSION   3 Preferred Brand Tier $39.00$98.00Q:180
/25Days
ALINIA 500MG TABLET   3 Preferred Brand Tier $39.00$98.00Q:12
/25Days
ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU   3 Preferred Brand Tier $39.00$98.00None
ALLEGRA-D 12 HOUR TABLET 60-120MG (500 CT)   4 Non-Preferred Brand Tier $98.00$270.00None
ALLEGRA-D 24 HOUR TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ALLOPURINOL SODIUM 500MG VIAL   2 Generic Tier $7.50$19.00None
ALLOPURINOL TABLET 300MG (1000 CT)   1 Value Generic Tier $2.50$5.00None
ALLOPURINOL TABLET USP 100MG (1000 CT)   1 Value Generic Tier $2.50$5.00None
ALOCRIL 2% EYE DROPS   4 Non-Preferred Brand Tier $98.00$270.00None
ALOMIDE 0.1% EYE DROPS   4 Non-Preferred Brand Tier $98.00$270.00None
ALORA 0.025MG PATCH   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
ALORA 0.05MG PATCH   3 Preferred Brand Tier $39.00$98.00None
ALORA 0.075MG PATCH   3 Preferred Brand Tier $39.00$98.00None
ALORA 0.1MG PATCH   3 Preferred Brand Tier $39.00$98.00None
ALPHAGAN P 0.1% DROPS   3 Preferred Brand Tier $39.00$98.00None
ALPHAGAN P 0.15% EYE DROPS   3 Preferred Brand Tier $39.00$98.00None
ALREX 0.2% EYE DROPS   3 Preferred Brand Tier $39.00$98.00None
ALTABAX 1% OINTMENT   3 Preferred Brand Tier $39.00$98.00None
ALTOPREV 20MG TABLET SR 24HR   4 Non-Preferred Brand Tier $98.00$270.00None
ALTOPREV 40MG TABLET SR 24HR   4 Non-Preferred Brand Tier $98.00$270.00None
ALTOPREV 60MG TABLET SR 24HR   4 Non-Preferred Brand Tier $98.00$270.00None
AMANTADINE 100MG 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
AMANTADINE 100MG TABLET   2 Generic Tier $7.50$19.00None
AMCINONIDE 0.1% CREAM   2 Generic Tier $7.50$19.00None
AMCINONIDE 0.1% LOTION   2 Generic Tier $7.50$19.00None
AMCINONIDE 0.1% OINTMENT 60GM TUBE   2 Generic Tier $7.50$19.00None
AMIFOSTINE FOR INJECTION 500MG/VIAL   2 Generic Tier $7.50$19.00None
AMIKACIN 250MG/ML VIAL   2 Generic Tier $7.50$19.00None
AMIKACIN 50MG/ML VIAL   2 Generic Tier $7.50$19.00None
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET   1 Value Generic Tier $2.50$5.00None
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT   2 Generic Tier $7.50$19.00None
AMINESS 5.2% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOPHYLLINE 100MG 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
AMINOPHYLLINE 200MG TABLET (1000 CT)   1 Value Generic Tier $2.50$5.00None
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD   2 Generic Tier $7.50$19.00None
AMINOSYN 10% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN 3.5% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN 5% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN 7% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN 7%-ELECTROLYTE SOL   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN 8.5% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 10% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 15% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 3.5% IN D25W IV   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
AMINOSYN II 3.5% M/D5W IV   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 3.5% W/ELEC DEX   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 4.25% IN D10W   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 4.25% IN D20W   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 4.25% W/ELEC DW   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 4.25%-D25W IV   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 5% IN D25W IV   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 7% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN II 8.5% ELECTROLYT   2 Generic Tier $7.50$19.00P
AMINOSYN II 8.5% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN M 3.5% IV 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
AMINOSYN PF INJECTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   2 Generic Tier $7.50$19.00P
AMINOSYN-HBC 7% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMINOSYN-HF 8% IV SOLUTION   2 Generic Tier $7.50$19.00P
AMINOSYN-PF 7% IV SOLUTION   3 Preferred Brand Tier $39.00$98.00P
AMIODARONE HCL 200MG TABLET (60 CT)   2 Generic Tier $7.50$19.00None
AMIODARONE HCL 400MG TABLET   2 Generic Tier $7.50$19.00None
AMIODARONE HCL INJECTION   2 Generic Tier $7.50$19.00None
AMITIZA 8MCG CAPSULE   3 Preferred Brand Tier $39.00$98.00P
AMITIZA CAPSULES 24MCG 60 CAP BOT   3 Preferred Brand Tier $39.00$98.00P
AMITRIP/CDP 25-10 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
AMITRIP/PERPHEN 10-2 TABLET   2 Generic Tier $7.50$19.00None
AMITRIP/PERPHEN 10-4 TABLET   2 Generic Tier $7.50$19.00None
AMITRIP/PERPHEN 25-2 TABLET   2 Generic Tier $7.50$19.00None
AMITRIP/PERPHEN 25-4 TABLET   2 Generic Tier $7.50$19.00None
AMITRIP/PERPHEN 50-4 TABLET   2 Generic Tier $7.50$19.00None
AMITRIPTYLINE HCL 100MG TABLET   1 Value Generic Tier $2.50$5.00None
AMITRIPTYLINE HCL 10MG TABLET   1 Value Generic Tier $2.50$5.00None
AMITRIPTYLINE HCL 150MG TABLET (100 CT)   1 Value Generic Tier $2.50$5.00None
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)   1 Value Generic Tier $2.50$5.00None
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)   1 Value Generic Tier $2.50$5.00None
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT   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
AMLODIPINE BESYLATE 10MG TABLET (90 CT)   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE 5MG TABLET (90 CT)   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE   2 Generic Tier $7.50$19.00None
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE   2 Generic Tier $7.50$19.00None
AMMONIUM LACTATE 12% CREAM   2 Generic Tier $7.50$19.00None
AMMONIUM LACTATE 12% LOTION   2 Generic Tier $7.50$19.00None
AMNESTEEM 10MG CAPSULE   2 Generic Tier $7.50$19.00None
AMNESTEEM 20MG 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
AMNESTEEM 40MG CAPSULE   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
AMOX TR-POTASSIUM CLAVULANATE 500-125MG TABLET   2 Generic Tier $7.50$19.00None
AMOXAPINE 100MG TABLET   2 Generic Tier $7.50$19.00None
AMOXAPINE 150MG TABLET   2 Generic Tier $7.50$19.00None
AMOXAPINE 25MG TABLET   2 Generic Tier $7.50$19.00None
AMOXAPINE 50MG 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
AMOXICILLIN 125MG TABLET CHEW   2 Generic Tier $7.50$19.00None
AMOXICILLIN 200MG TABLET CHEW   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN 250MG CAPSULE   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN 400MG TABLET CHEW   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN 500MG CAPSULE   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN 500MG TABLET (100 CT)   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN 875MG TABLET   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT   2 Generic Tier $7.50$19.00None
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT   2 Generic Tier $7.50$19.00None
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL   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
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL   1 Value Generic Tier $2.50$5.00None
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT)   1 Value Generic Tier $2.50$5.00None
AMOXIL 250MG/5ML SUSPENSION   2 Generic Tier $7.50$19.00None
AMOXIL CAPSULES 500MG   2 Generic Tier $7.50$19.00None
AMPHET ASP/ AMPHET/ D-AMPHET 5MG TABLET   2 Generic Tier $7.50$19.00P
AMPHETAMINE SALT COMBO 12.5MG TABLET   2 Generic Tier $7.50$19.00P
AMPHETAMINE SALT COMBO 15MG TABLET   2 Generic Tier $7.50$19.00P
AMPHETAMINE SALT COMBO 30MG TABLET   2 Generic Tier $7.50$19.00P
AMPHETAMINE SALT COMBO 7.5MG TABLET   2 Generic Tier $7.50$19.00P
AMPHETAMINE SALTS 20MG TABLET   2 Generic Tier $7.50$19.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPHOTERICIN B FOR INJECTION 50 MG   2 Generic Tier $7.50$19.00None
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL   2 Generic Tier $7.50$19.00None
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL   2 Generic Tier $7.50$19.00None
AMPICILLIN CAPSULES 250MG 100 BOT   2 Generic Tier $7.50$19.00None
AMPICILLIN CAPSULES 500MG 100 BOT   2 Generic Tier $7.50$19.00None
AMPICILLIN FOR INJECTION POWDER   2 Generic Tier $7.50$19.00None
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL   2 Generic Tier $7.50$19.00None
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT   2 Generic Tier $7.50$19.00None
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT   2 Generic Tier $7.50$19.00None
AMPICILLIN POWDER FOR INJECTION 1 GM/ML   2 Generic Tier $7.50$19.00None
ANAGRELIDE HCL 0.5MG 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
ANAGRELIDE HCL 1MG CAPSULE   2 Generic Tier $7.50$19.00None
ANCOBON 250MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
ANCOBON 500MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
ANDRODERM 2.5MG/24HR PATCH   3 Preferred Brand Tier $39.00$98.00P
ANDRODERM 5MG/24HR PATCH   3 Preferred Brand Tier $39.00$98.00P
ANDROGEL 1%(50MG) GEL PACKET   3 Preferred Brand Tier $39.00$98.00P
ANTABUSE 250MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ANTIVERT 50MG TABLET   3 Preferred Brand Tier $39.00$98.00None
APIDRA 100UNITS/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
APOKYN FOR INJECTION 30MG 5 CTG   5 Specialty Tier 33%N/ANone
APRI 0.15-0.03 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
APRISO CP24   3 Preferred Brand Tier $39.00$98.00None
APTIVUS 250MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   3 Preferred Brand Tier $39.00$98.00None
ARALAST 500MG VIAL   5 Specialty Tier 33%N/ANone
ARANELLE 7-9-5 TABLET   2 Generic Tier $7.50$19.00None
ARICEPT 10MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ARICEPT 5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ARICEPT ODT 10MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ARICEPT ODT 5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ARIMIDEX 1MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ARIXTRA 10MG SYRINGE   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
ARIXTRA 2.5MG SYRINGE   3 Preferred Brand Tier $39.00$98.00None
ARIXTRA 5MG SYRINGE   3 Preferred Brand Tier $39.00$98.00None
ARIXTRA 7.5MG SYRINGE   3 Preferred Brand Tier $39.00$98.00None
AROMASIN 25MG TABLET   3 Preferred Brand Tier $39.00$98.00None
ASACOL 400MG TABLET EC   4 Non-Preferred Brand Tier $98.00$270.00None
ASCOMP W/CODEINE 30-50-325 CAPSULE   2 Generic Tier $7.50$19.00None
ASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED   3 Preferred Brand Tier $39.00$98.00Q:7
/25Days
ASMANEX TWISTHALER 220MCG #120   3 Preferred Brand Tier $39.00$98.00Q:58
/25Days
ASMANEX TWISTHALER 220MCG #30   3 Preferred Brand Tier $39.00$98.00Q:15
/25Days
ASMANEX TWISTHALER 220MCG #60   3 Preferred Brand Tier $39.00$98.00Q:29
/25Days
ASTELIN 137MCG AEROSOL SPRAY W/PUMP   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ASTEPRO NASAL SPRAY 137 MCG/SPRY   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
ASTRAMORPH-PF 0.5MG/ML VIAL   2 Generic Tier $7.50$19.00None
ASTRAMORPH-PF 1MG/ML VIAL   2 Generic Tier $7.50$19.00None
ATACAND 16MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND 32MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND 4MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND 8MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND HCT 16/12.5MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND HCT 32/12.5MG TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
ATACAND HCT TABLETS 32;25MG;MG 90 TABLETS BOT   4 Non-Preferred Brand Tier $98.00$270.00None
ATAMET   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATENOLOL 25MG TABLET (100 CT)   1 Value Generic Tier $2.50$5.00None
ATENOLOL TABLET USP 50MG (100 CT)   1 Value Generic Tier $2.50$5.00None
ATENOLOL TABLETS USP 100MG 1 BLPK   1 Value Generic Tier $2.50$5.00None
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT)   1 Value Generic Tier $2.50$5.00None
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   1 Value Generic Tier $2.50$5.00None
ATRIPLA TABLET 600MG/200MG   5 Specialty Tier 33%N/ANone
ATROPINE 0.05MG/ML SYRINGE   2 Generic Tier $7.50$19.00None
ATROPINE 0.1MG/ML SYRINGE   2 Generic Tier $7.50$19.00None
ATROVENT HFA AER 17MCG   3 Preferred Brand Tier $39.00$98.00Q:26
/25Days
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML   3 Preferred Brand Tier $39.00$98.00None
AUGMENTIN 125 SUSPENSION   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
AUGMENTIN 250 SUSPENSION   4 Non-Preferred Brand Tier $98.00$270.00None
AUGMENTIN TABLETS COMBO   4 Non-Preferred Brand Tier $98.00$270.00None
AUGMENTIN XR 1000-62.5 TABLET   4 Non-Preferred Brand Tier $98.00$270.00None
AVALIDE 150-12.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVALIDE 300-12.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVALIDE 300-25MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDAMET 2MG/1000MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDAMET 2MG/500MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDAMET 4MG/500MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDAMET TABLET 4-1000MG   3 Preferred Brand Tier $39.00$98.00None
AVANDARYL 4MG/1MG 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
AVANDARYL 4MG/2MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDARYL 4MG/4MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDARYL 8MG-2MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDARYL 8MG-4MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDIA 2MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVANDIA 4MG TABLET (90 CT)   3 Preferred Brand Tier $39.00$98.00None
AVANDIA 8MG TABLET (90 CT)   3 Preferred Brand Tier $39.00$98.00None
AVAPRO 150MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVAPRO 300MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVAPRO 75MG TABLET (30 CT)   3 Preferred Brand Tier $39.00$98.00None
AVASTIN 100MG/4ML VIAL   5 Specialty Tier 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVELOX 400MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVELOX ABC PACK 400MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AVELOX IV 400MG/250ML   3 Preferred Brand Tier $39.00$98.00None
AVIANE 0.1-0.02 TABLET   2 Generic Tier $7.50$19.00None
AVINZA 120MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVINZA 30MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVINZA 60MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVINZA 90MG CAPSULE MULTIPHASIC RELEASE 24 HR   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVINZA CAPSULES EXTENDED RELEASE 45MG 100 BOTPL   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVINZA CAPSULES EXTENDED RELEASE 75MG 100 BOTPL   3 Preferred Brand Tier $39.00$98.00Q:60
/25Days
AVITA 0.025% CREAM   2 Generic Tier $7.50$19.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVODART 0.5MG SOFTGEL   3 Preferred Brand Tier $39.00$98.00None
AZASAN 100MG TABLET   3 Preferred Brand Tier $39.00$98.00P
AZASAN 75MG TABLET   3 Preferred Brand Tier $39.00$98.00P
AZASITE 1% DROPS   3 Preferred Brand Tier $39.00$98.00None
AZATHIOPRINE 50MG TABLET   2 Generic Tier $7.50$19.00P
AZATHIOPRINE SOD 100MG VIAL   2 Generic Tier $7.50$19.00None
AZELEX 20% CREAM 30GM TUBE   3 Preferred Brand Tier $39.00$98.00None
AZILECT 0.5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AZILECT 1MG TABLET   3 Preferred Brand Tier $39.00$98.00None
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZITHROMYCIN 250MG TABLET (30 CT)   2 Generic Tier $7.50$19.00None
AZITHROMYCIN 500MG TABLET (30 CT)   2 Generic Tier $7.50$19.00None
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD   2 Generic Tier $7.50$19.00None
AZITHROMYCIN TABLET 600MG (30 CT)   2 Generic Tier $7.50$19.00None
AZMACORT INHALATION AEROSOL .1MG/1IHL 20 GM CSTR   4 Non-Preferred Brand Tier $98.00$270.00Q:40
/25Days
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT   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.