2011 Medicare Part D Plan Formulary Information |
Geisinger Gold Classic 2 $0 Deductible Rx (HMO) (H3954-039-0)
Benefit Details
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The Geisinger Gold Classic 2 $0 Deductible Rx (HMO) (H3954-039-0) Formulary Drugs Starting with the Letter C in Lehigh County, PA: CMS MA Region 6 which includes: PA
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CALCIUM ACETATE CAPSULE 667 MG ![Compare how all Medicare Part D PDP plans in PA cover CALCIUM ACETATE CAPSULE 667 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CAMPATH 30MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CAMPATH 30MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CAMPRAL 333MG DOSE PAK ![Compare how all Medicare Part D PDP plans in PA cover CAMPRAL 333MG DOSE PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in PA cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CAPREOMYCIN 500 MG/ML INJECTABLE SOLUTION [CAPASTAT] ![Compare how all Medicare Part D PDP plans in PA cover CAPREOMYCIN 500 MG/ML INJECTABLE SOLUTION [CAPASTAT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CAPTOPRIL/HCTZ 25/15 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL/HCTZ 25/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBAMAZEPINE ORAL SUSPENSION 200 MG ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ORAL SUSPENSION 200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBATROL 100MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 100MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CARBATROL 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CARBATROL 300MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARBATROL 300MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARIMUNE NF 3GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CARIMUNE NF 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
CARISOPRODOL TABLET USP 350MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARISOPRODOL TABLET USP 350MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARVEDILOL 12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARVEDILOL 25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARVEDILOL 3.125MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 3.125MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CARVEDILOL 6.25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 6.25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CASODEX 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CASODEX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEENU 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEENU 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEENU 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEENU 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEFACLOR CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFADROXIL 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFAZOLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFAZOLIN 1GM/D5W BAG ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 1GM/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFOTAXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFOTAXIME FOR INJECTION 2GM 25 VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 2GM 25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFOTAXIME FOR INJECTION 500MG 10 VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOTAXIME FOR INJECTION 500MG 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFPROZIL 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFPROZIL TABLETS 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL TABLETS 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTRIAXONE 10GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFUROXIME 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFUROXIME AXETIL 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CELEBREX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELEBREX 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELEBREX 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CELEBREX 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CELEBREX 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELLCEPT 200MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT 200MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELLCEPT 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELLCEPT CAPSULES 250MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CELLCEPT CAPSULES 250MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CELONTIN 300MG KAPSEAL ![Compare how all Medicare Part D PDP plans in PA cover CELONTIN 300MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CENESTIN 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CENESTIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CENESTIN 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CENESTIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CENESTIN 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CENESTIN 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEPHALEXIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEPHALEXIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEPHALEXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEPHALEXIN CAPSULES 500MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN CAPSULES 500MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CEREDASE 80UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEREDASE 80UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CEREZYME INJ 200UNIT ![Compare how all Medicare Part D PDP plans in PA cover CEREZYME INJ 200UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
CHANTIX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHANTIX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | Q:60 /30Days |
CHANTIX 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHANTIX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | Q:60 /30Days |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in PA cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLOROQUINE PH 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PH 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLOROTHIAZIDE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROTHIAZIDE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLOROTHIAZIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROTHIAZIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE 25MG/ML AMP ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 25MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROMAZINE HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROPAMIDE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROPAMIDE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORPROPAMIDE 250MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROPAMIDE 250MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORTHALIDONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHLORTHALIDONE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CHORIONIC GONAD 10000U VIAL ![Compare how all Medicare Part D PDP plans in PA cover CHORIONIC GONAD 10000U VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CILOSTAZOL 50MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL 50MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CIMETIDINE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CIMETIDINE HCL 300MG/5ML SOL ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE HCL 300MG/5ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CIMZIA 200 MG/ML SYRINGE KIT ![Compare how all Medicare Part D PDP plans in PA cover CIMZIA 200 MG/ML SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P Q:2 /30Days |
CIMZIA KIT ![Compare how all Medicare Part D PDP plans in PA cover CIMZIA KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P Q:2 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CIPROFLOXACIN 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CIPROFLOXACIN 400 MG/40 ML VL ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 400 MG/40 ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CIPROFLOXACIN HCL 0.3% DROPS ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CITALOPRAM HBR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CITOLOPRAM HBR 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CITOLOPRAM HBR 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLARITHROMYCIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLARITHROMYCIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLEMASTINE FUM 2.68MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLEMASTINE FUM 2.68MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLEMASTINE FUMARATE SYRUP ![Compare how all Medicare Part D PDP plans in PA cover CLEMASTINE FUMARATE SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLINDAMYCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLINDAMYCIN HYDROCHLORIDE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HYDROCHLORIDE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLINDESSE 2% VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLINDESSE 2% VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOBETASOL 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOZAPINE 100 MG DISINTEGRATING TABLET [FAZACLO] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 100 MG DISINTEGRATING TABLET [FAZACLO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CLOZAPINE 100 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 100 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOZAPINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE 25 MG DISINTEGRATING TABLET [FAZACLO] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 25 MG DISINTEGRATING TABLET [FAZACLO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
COLCHICINE 0.6 MG ORAL TABLET [COLCRYS] ![Compare how all Medicare Part D PDP plans in PA cover COLCHICINE 0.6 MG ORAL TABLET [COLCRYS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
COLESTIPOL HCL 5G GRANULES ![Compare how all Medicare Part D PDP plans in PA cover COLESTIPOL HCL 5G GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
COLISTIMETHATE 150MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover COLISTIMETHATE 150MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COMBIVENT INHALER ![Compare how all Medicare Part D PDP plans in PA cover COMBIVENT INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COMBIVIR TABLETS ![Compare how all Medicare Part D PDP plans in PA cover COMBIVIR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
COMTAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COMTAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PA cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CONDYLOX GEL 0.5% 3.5 GM CRTN ![Compare how all Medicare Part D PDP plans in PA cover CONDYLOX GEL 0.5% 3.5 GM CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CONDYLOX TOPICAL SOLUTION .5% 3.5 ML CTR ![Compare how all Medicare Part D PDP plans in PA cover CONDYLOX TOPICAL SOLUTION .5% 3.5 ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in PA cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
COPEGUS 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COPEGUS 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CORTISONE ACETATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CORTISONE ACETATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
COZAAR 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COZAAR 25MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 25MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
COZAAR 50MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in PA cover COZAAR 50MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CRESTOR 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRESTOR 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRESTOR 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRESTOR 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CRESTOR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRIXIVAN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRIXIVAN 333MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 333MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CRIXIVAN 400MG CAPSULE (120 CT) ![Compare how all Medicare Part D PDP plans in PA cover CRIXIVAN 400MG CAPSULE (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CROMOLYN NEBULIZER SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CROMOLYN NEBULIZER SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
CUPRIMINE CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover CUPRIMINE CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE HCL 5MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYCLOSPORINE 50MG/ML AMP ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 50MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYKLOKAPRON 100MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover CYKLOKAPRON 100MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CYMBALTA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYMBALTA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYPROHEPTADINE HCL 4 MG ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE HCL 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in PA cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$39.00 | $97.50 | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYTOMEL 25MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYTOMEL 50MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |
CYTOMEL 5MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CYTOMEL 5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$69.00 | $172.50 | None |