Q1Medicare.com 2010 Medicare Part D or Medicare Advantage Plan Formulary Browser

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 V in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter V Drug Name	Drug Tier Information		Cost-Sharing		Drug Usage Mgmt
Drugs Starting with Letter V Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VAGIFEM 25MCG VAGINAL TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VALCYTE 450MG TABLET	5	Specialty Tier	33%	N/A	None
VALPROATE SOD 500MG/5ML VL	2	Generic Tier	$7.50	$19.00	None
VALPROIC ACID 250MG CAPSULE	2	Generic Tier	$7.50	$19.00	None
VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT	2	Generic Tier	$7.50	$19.00	None
VALTREX 1GM CAPLET (90 CT)	3	Preferred Brand Tier	$39.00	$98.00	None
VALTREX 500MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VANACET 5/500 TABLET	2	Generic Tier	$7.50	$19.00	None
VANCOCIN HCL 125MG PULVULE	5	Specialty Tier	33%	N/A	None
VANCOCIN HCL 1G/200ML BAG	3	Preferred Brand Tier	$39.00	$98.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VANCOCIN HCL 250MG PULVULE	5	Specialty Tier	33%	N/A	None
VANCOMYCIN HCL 10GM VIAL	2	Generic Tier	$7.50	$19.00	None
VANDAZOLE 0.75% GEL WITH APPLICATOR	2	Generic Tier	$7.50	$19.00	None
VAQTA 25 UNITS/0.5ML VIAL	3	Preferred Brand Tier	$39.00	$98.00	None
VARIVAX VACCINE W/DILUENT	3	Preferred Brand Tier	$39.00	$98.00	None
VEETIDS 125MG/5ML ORAL SUSP	2	Generic Tier	$7.50	$19.00	None
VEETIDS 250MG TABLET	2	Generic Tier	$7.50	$19.00	None
VEETIDS 500MG TABLET	2	Generic Tier	$7.50	$19.00	None
VELCADE 3.5MG VIAL	5	Specialty Tier	33%	N/A	None
VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK)	2	Generic Tier	$7.50	$19.00	None
VENLAFAXINE HCL 100MG TABLET	2	Generic Tier	$7.50	$19.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VENLAFAXINE HCL 25MG TABLET	2	Generic Tier	$7.50	$19.00	None
VENLAFAXINE HCL 37.5MG TABLET	2	Generic Tier	$7.50	$19.00	None
VENLAFAXINE HCL 50MG TABLET	2	Generic Tier	$7.50	$19.00	None
VENLAFAXINE HCL 75MG TABLET	2	Generic Tier	$7.50	$19.00	None
VENLAFAXINE HCL ER TAB	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VENLAFAXINE HCL ER TAB 225 MG	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VENLAFAXINE HCL ER TAB 37.5 MG	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VENLAFAXINE HCL ER TAB 75 MG	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VENTAVIS ILOPROST INHALATION SOLUTION 10MCG/ML 1 ML AMP	5	Specialty Tier	33%	N/A	P
VERAPAMIL 120MG CAP PELLET	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL 120MG TABLET SA	2	Generic Tier	$7.50	$19.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VERAPAMIL 180MG CAP PELLET	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL 2.5MG/ML AMPUL	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL 240MG CAP PELLET	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL 40MG TABLET	1	Value Generic Tier	$2.50	$5.00	None
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT)	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL HCL 120MG TABLET	1	Value Generic Tier	$2.50	$5.00	None
VERAPAMIL HCL 18OMG ER TABLET	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL HCL 240MG TABLET SA	2	Generic Tier	$7.50	$19.00	None
VERAPAMIL HCL 80MG TABLET	1	Value Generic Tier	$2.50	$5.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VESANOID 10MG CAPSULE	5	Specialty Tier	33%	N/A	None
VESICARE 10MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VESICARE 5MG TABLET (90 CT)	3	Preferred Brand Tier	$39.00	$98.00	None
VFEND 200MG TABLET	5	Specialty Tier	33%	N/A	None
VFEND 40MG/ML SUSPENSION	5	Specialty Tier	33%	N/A	None
VFEND 50MG TABLET	5	Specialty Tier	33%	N/A	None
VFEND IV 200MG VIAL	5	Specialty Tier	33%	N/A	None
VICODIN HP TABLET 10-660	2	Generic Tier	$7.50	$19.00	None
VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU	5	Specialty Tier	33%	N/A	None
VIDEX 2GM PEDIATRIC TUBEX	3	Preferred Brand Tier	$39.00	$98.00	None
VIGAMOX 0.5% EYE DROPS	3	Preferred Brand Tier	$39.00	$98.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VIMPAT INJECTION 10MG/ML 10 X 20ML VIALGL	3	Preferred Brand Tier	$39.00	$98.00	None
VIMPAT TABLETS 100MG 60 BOTPL	3	Preferred Brand Tier	$39.00	$98.00	None
VIMPAT TABLETS 150MG 60 BOTPL	3	Preferred Brand Tier	$39.00	$98.00	None
VIMPAT TABLETS 200MG 60 BOTPL	3	Preferred Brand Tier	$39.00	$98.00	None
VIMPAT TABLETS 50MG 60 BOTPL	3	Preferred Brand Tier	$39.00	$98.00	None
VINBLASTINE SULF 10MG VIAL	3	Preferred Brand Tier	$39.00	$98.00	None
VINCRISTINE 1MG/ML VIAL	2	Generic Tier	$7.50	$19.00	None
VINCRISTINE 1MG/ML VIAL	2	Generic Tier	$7.50	$19.00	None
VINORELBINE 10MG/ML VIAL 5ML VIAL	2	Generic Tier	$7.50	$19.00	None
VIOKASE 16 TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VIOKASE POWDER	3	Preferred Brand Tier	$39.00	$98.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VIRACEPT 250MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VIRACEPT 50MG/GM ORAL POWDER	3	Preferred Brand Tier	$39.00	$98.00	None
VIRACEPT 625MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VIRAMUNE 200MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VIRAMUNE 50MG/5ML SUSP	3	Preferred Brand Tier	$39.00	$98.00	None
VIREAD 300MG TABLET	3	Preferred Brand Tier	$39.00	$98.00	None
VISICOL 1.5GM TABLET	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VIVELLE-DOT 0.025MG PATCH	3	Preferred Brand Tier	$39.00	$98.00	None
VIVELLE-DOT 0.0375MG PATCH 8 POUCH CRTN	3	Preferred Brand Tier	$39.00	$98.00	None
VIVELLE-DOT 0.05MG PATCH 8 POUCH CRTN	3	Preferred Brand Tier	$39.00	$98.00	None
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN	3	Preferred Brand Tier	$39.00	$98.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
VIVELLE-DOT 0.1MG PATCH 8 POUCH CRTN	3	Preferred Brand Tier	$39.00	$98.00	None
VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE	3	Preferred Brand Tier	$39.00	$98.00	None
VOLTAREN 1% GEL	3	Preferred Brand Tier	$39.00	$98.00	None
VYTORIN 10/10MG TABLET (1000 CT)	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VYTORIN 10/20MG TABLET (1000 CT)	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VYTORIN 10/40MG TABLET (500 CT)	4	Non-Preferred Brand Tier	$98.00	$270.00	None
VYTORIN 10/80MG TABLET 2500 BOT	4	Non-Preferred Brand Tier	$98.00	$270.00	None

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.