2010 Medicare Part D Plan Formulary Information |
Blue Cross MedicareRx Gold (PDP) (S5596-035-0)
Benefit Details
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The Blue Cross MedicareRx Gold (PDP) (S5596-035-0) Formulary Drugs Starting with the Letter I in CMS PDP Region 32 which includes: CA
|
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBUPROFEN 100MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in CA cover IBUPROFEN 100MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IBUPROFEN TABLET 400MG 1 BLPK ![Compare how all Medicare Part D PDP plans in CA cover IBUPROFEN TABLET 400MG 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IBUPROFEN TABLETS 600MG 90 BOT ![Compare how all Medicare Part D PDP plans in CA cover IBUPROFEN TABLETS 600MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IBUPROFEN TABLETS USP 800MG 10 X 10 BOXUD ![Compare how all Medicare Part D PDP plans in CA cover IBUPROFEN TABLETS USP 800MG 10 X 10 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IDAMYCIN PFS 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover IDAMYCIN PFS 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IDARUBICIN HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover IDARUBICIN HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IFEX INJECTION 3GM/ML 3GM VIALSD ![Compare how all Medicare Part D PDP plans in CA cover IFEX INJECTION 3GM/ML 3GM VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
IFOSFAMIDE 1GM VIAL ![Compare how all Medicare Part D PDP plans in CA cover IFOSFAMIDE 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in CA cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in CA cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMDUR 120MG TABLET SA ![Compare how all Medicare Part D PDP plans in CA cover IMDUR 120MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
IMDUR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in CA cover IMDUR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
IMDUR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in CA cover IMDUR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE PAMOATE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE PAMOATE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE PAMOATE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE PAMOATE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE PAMOATE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE PAMOATE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMIPRAMINE PAMOATE 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover IMIPRAMINE PAMOATE 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
IMITREX 100MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:9 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMITREX 20MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 20MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:8 /30Days |
IMITREX 25MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:9 /30Days |
IMITREX 4MG/0.5ML KIT REFILL ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 4MG/0.5ML KIT REFILL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | Q:4 /30Days |
IMITREX 50MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:9 /30Days |
IMITREX 5MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 5MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:16 /30Days |
IMITREX 6MG/0.5ML SYRNG KIT ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 6MG/0.5ML SYRNG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | Q:4 /30Days |
IMITREX 6MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover IMITREX 6MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | Q:4 /30Days |
IMOVAX RABIES VACCINE 2.5UNT/ML ![Compare how all Medicare Part D PDP plans in CA cover IMOVAX RABIES VACCINE 2.5UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | None |
IMURAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover IMURAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | P |
INCRELEX 40MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover INCRELEX 40MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
INDAPAMIDE 1.25MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in CA cover INDAPAMIDE 1.25MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDAPAMIDE 2.5MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in CA cover INDAPAMIDE 2.5MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT ![Compare how all Medicare Part D PDP plans in CA cover INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDOCIN SR 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in CA cover INDOCIN SR 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INDOMETHACIN 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover INDOMETHACIN 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
INDOMETHACIN 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover INDOMETHACIN 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
INDOMETHACIN 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in CA cover INDOMETHACIN 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
INFANRIX VACCINE VIAL 25-10UNT/.5ML ![Compare how all Medicare Part D PDP plans in CA cover INFANRIX VACCINE VIAL 25-10UNT/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INFERGEN SOLUTION FOR INJECTION 15MCG/0.5ML ![Compare how all Medicare Part D PDP plans in CA cover INFERGEN SOLUTION FOR INJECTION 15MCG/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | P |
INFUMORPH 10MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in CA cover INFUMORPH 10MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
INFUMORPH 25MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in CA cover INFUMORPH 25MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
INNOPRAN XL (PROPRANOLOL HCL) 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in CA cover INNOPRAN XL (PROPRANOLOL HCL) 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INNOPRAN XL (PROPRANOLOL HCL) 80MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in CA cover INNOPRAN XL (PROPRANOLOL HCL) 80MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INSPRA 25MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover INSPRA 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:45 /30Days |
INSPRA 50MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover INSPRA 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INTAL INH AER 800MCG ![Compare how all Medicare Part D PDP plans in CA cover INTAL INH AER 800MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | Q:30 /30Days |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
INTRALIPID 20% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in CA cover INTRALIPID 20% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | P |
INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG ![Compare how all Medicare Part D PDP plans in CA cover INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 |
INTRON A 10MMU INJ PEN ![Compare how all Medicare Part D PDP plans in CA cover INTRON A 10MMU INJ PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | P |
INTRON A 10MMU VIAL ![Compare how all Medicare Part D PDP plans in CA cover INTRON A 10MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | P |
INTRON A 3MMU INJECTION PEN ![Compare how all Medicare Part D PDP plans in CA cover INTRON A 3MMU INJECTION PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | P |
INTRON A 5MMU MULTIDOSE PEN ![Compare how all Medicare Part D PDP plans in CA cover INTRON A 5MMU MULTIDOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | P |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | P |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in CA cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in CA cover INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:30 /30Days |
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in CA cover INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:60 /30Days |
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in CA cover INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:30 /30Days |
INVERSINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover INVERSINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
INVIRASE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover INVIRASE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IONOSOL B-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in CA cover IONOSOL B-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in CA cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
IONOSOL T-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in CA cover IONOSOL T-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
IOPIDINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in CA cover IOPIDINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:20 /30Days |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in CA cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in CA cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand Certain Generic Drugs |
$43.00 | $107.50 | None |
IPRATROPIUM BROMIDE 21MCG AEROSOL SPRAY ![Compare how all Medicare Part D PDP plans in CA cover IPRATROPIUM BROMIDE 21MCG AEROSOL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | Q:30 /30Days |
IPRATROPIUM BROMIDE 42MCG AEROSOL SPRAY ![Compare how all Medicare Part D PDP plans in CA cover IPRATROPIUM BROMIDE 42MCG AEROSOL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | Q:15 /30Days |
IPRATROPIUM BROMIDE INHALATION SOLUTION 0.02% 60 X 2.5ML VIALSD ![Compare how all Medicare Part D PDP plans in CA cover IPRATROPIUM BROMIDE INHALATION SOLUTION 0.02% 60 X 2.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | P |
IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION SOLUTION 0.5MG/3ML 33 CRTN ![Compare how all Medicare Part D PDP plans in CA cover IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION SOLUTION 0.5MG/3ML 33 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IQUIX 1.5% DROPS ![Compare how all Medicare Part D PDP plans in CA cover IQUIX 1.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:20 /30Days |
IRESSA 250MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover IRESSA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
IRINOTECAN HCL INJECTION 20MG ![Compare how all Medicare Part D PDP plans in CA cover IRINOTECAN HCL INJECTION 20MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | P |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |
ISMO 20MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISMO 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISOCHRON 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in CA cover ISOCHRON 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOLYTE H IN 5% DEXTROSE ![Compare how all Medicare Part D PDP plans in CA cover ISOLYTE H IN 5% DEXTROSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOLYTE M IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in CA cover ISOLYTE M IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in CA cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOLYTE S IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in CA cover ISOLYTE S IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOLYTE S SOLUTION FOR INJECTION ![Compare how all Medicare Part D PDP plans in CA cover ISOLYTE S SOLUTION FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 |
ISONARIF 300-150MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover ISONARIF 300-150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISONIAZID 100MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISONIAZID 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISONIAZID 300MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISONIAZID 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in CA cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISONIAZID INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in CA cover ISONIAZID INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOPTIN SR 120MG ![Compare how all Medicare Part D PDP plans in CA cover ISOPTIN SR 120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISOPTIN SR 180MG ![Compare how all Medicare Part D PDP plans in CA cover ISOPTIN SR 180MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISOPTIN SR 240MG (500 Count) ![Compare how all Medicare Part D PDP plans in CA cover ISOPTIN SR 240MG (500 Count).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISORDIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISORDIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISORDIL TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover ISORDIL TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | None |
ISOSORBIDE DN 10MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE DN 2.5MG TABLET SL ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 2.5MG TABLET SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE DN 20MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE DN 30MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE DN 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE DN 5MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE DN 5MG TABLET SL ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE DN 5MG TABLET SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE MN 10MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE MN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE MONONITRATE TABLETS 20MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE MONONITRATE TABLETS 20MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in CA cover ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOTON GENTAMICIN 60MG/100ML ![Compare how all Medicare Part D PDP plans in CA cover ISOTON GENTAMICIN 60MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in CA cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | None |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in CA cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand Certain Generic Drugs |
$85.00 | $212.50 | Q:30 /30Days |
ITRACONAZOLE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover ITRACONAZOLE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$7.00 | $10.50 | P |
IV BUSULFEX 6MG 1 X 10ML VIALGL ![Compare how all Medicare Part D PDP plans in CA cover IV BUSULFEX 6MG 1 X 10ML VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable Drugs |
33% | 33% | None |
IXEMPRA KIT 45MG ![Compare how all Medicare Part D PDP plans in CA cover IXEMPRA KIT 45MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty Drugs |
33% | N/A | None |