2011 Medicare Part D Plan Formulary Information |
SeniorBlue - Option 1 (HMO) (H3962-001-0)
Benefit Details
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The SeniorBlue - Option 1 (HMO) (H3962-001-0) Formulary Drugs Starting with the Letter S in Snyder County, PA: CMS MA Region 6 which includes: PA
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SAIZEN 5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SAIZEN 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SAIZEN 8.8MG CLICK.EASY CARTG ![Compare how all Medicare Part D PDP plans in PA cover SAIZEN 8.8MG CLICK.EASY CARTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANCTURA TABLETS ![Compare how all Medicare Part D PDP plans in PA cover SANCTURA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SANCTURA XR 60MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in PA cover SANCTURA XR 60MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in PA cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | S Q:1 /15Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in PA cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SANDOSTATIN 0.05MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN 0.05MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN 0.1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN 0.1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SANDOSTATIN 0.2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN 0.2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN 0.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN 0.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in PA cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SARAFEM TABS ![Compare how all Medicare Part D PDP plans in PA cover SARAFEM TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S |
SARAFEM TABS ![Compare how all Medicare Part D PDP plans in PA cover SARAFEM TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in PA cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in PA cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in PA cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in PA cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SAXAGLIPTIN 2.5 MG ORAL TABLET [ONGLYZA] ![Compare how all Medicare Part D PDP plans in PA cover SAXAGLIPTIN 2.5 MG ORAL TABLET [ONGLYZA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SAXAGLIPTIN 5 MG ORAL TABLET [ONGLYZA] ![Compare how all Medicare Part D PDP plans in PA cover SAXAGLIPTIN 5 MG ORAL TABLET [ONGLYZA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SEASONALE 0.15-0.03 TABLET DOSE PACK 3 MONTHS ![Compare how all Medicare Part D PDP plans in PA cover SEASONALE 0.15-0.03 TABLET DOSE PACK 3 MONTHS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS ![Compare how all Medicare Part D PDP plans in PA cover SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SECTRAL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SECTRAL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SECTRAL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SECTRAL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in PA cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK ![Compare how all Medicare Part D PDP plans in PA cover SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK ![Compare how all Medicare Part D PDP plans in PA cover SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SEPTRA 80/400 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEPTRA 80/400 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SEPTRA DS TABLET 800-160 ![Compare how all Medicare Part D PDP plans in PA cover SEPTRA DS TABLET 800-160.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in PA cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SEROMYCIN CAPSULES 250MG ![Compare how all Medicare Part D PDP plans in PA cover SEROMYCIN CAPSULES 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | Q:90 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:30 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:30 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:60 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:30 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in PA cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROSTIM 4MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SEROSTIM 4MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SEROSTIM 5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SEROSTIM 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SEROSTIM 6MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SEROSTIM 6MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:60 /30Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:30 /30Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:60 /30Days |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in PA cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in PA cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in PA cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SILVADENE 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover SILVADENE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in PA cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in PA cover SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:60 /30Days |
SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in PA cover SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:60 /30Days |
SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in PA cover SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:60 /30Days |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:60 /30Days |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:60 /30Days |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in PA cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | S |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:30 /30Days |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in PA cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:30 /30Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:30 /30Days |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:30 /30Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SINEMET CR 25/100 TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover SINEMET CR 25/100 TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SINEMET CR 50/200 TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover SINEMET CR 50/200 TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SINEMET-10/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SINEMET-10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SINEMET-25/100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SINEMET-25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SINEMET-25/250 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SINEMET-25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in PA cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PA cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PA cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SKELAXIN 800MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SKELAXIN 800MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SKELID 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SKELID 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in PA cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CHLORIDE INJECTION 3% 24X500ML BAG ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CHLORIDE INJECTION 3% 24X500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM LACTATE 1/6MOLAR INJ ![Compare how all Medicare Part D PDP plans in PA cover SODIUM LACTATE 1/6MOLAR INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in PA cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in PA cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOLODYN 135MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOLODYN 135MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOLODYN 45MG TABLET SR 24HR (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SOLODYN 45MG TABLET SR 24HR (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOLODYN 90MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOLODYN 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOLODYN ER 115 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOLODYN ER 115 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOLODYN ER 65 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOLODYN ER 65 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOMA 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOMA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOMA TABLETS ![Compare how all Medicare Part D PDP plans in PA cover SOMA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in PA cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SONATA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SONATA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:30 /30Days |
SONATA 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SONATA 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | S Q:30 /30Days |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SORIATANE 22.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SORIATANE 22.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in PA cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPECTRACEF 400 MG DOSE PACK TB ![Compare how all Medicare Part D PDP plans in PA cover SPECTRACEF 400 MG DOSE PACK TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPECTRACEF TABLETS 200 MG ![Compare how all Medicare Part D PDP plans in PA cover SPECTRACEF TABLETS 200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in PA cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPORANOX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SPORANOX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SPORANOX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SPORANOX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | P |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in PA cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in PA cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STADOL 2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover STADOL 2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in PA cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STARLIX 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover STARLIX 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STARLIX 60MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover STARLIX 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STAVZOR 125MG CPDR ![Compare how all Medicare Part D PDP plans in PA cover STAVZOR 125MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STAVZOR 250MG CPDR ![Compare how all Medicare Part D PDP plans in PA cover STAVZOR 250MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STAVZOR 500MG CPDR ![Compare how all Medicare Part D PDP plans in PA cover STAVZOR 500MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
STERILE VANCOMYCIN HYDROCHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover STERILE VANCOMYCIN HYDROCHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
STIMATE 1.5MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover STIMATE 1.5MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRIANT 30MG MUCOADHESIVE ![Compare how all Medicare Part D PDP plans in PA cover STRIANT 30MG MUCOADHESIVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUBUTEX 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUBUTEX 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUBUTEX 8MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUBUTEX 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULAR 17MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover SULAR 17MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SULAR 25.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover SULAR 25.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SULAR 34MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover SULAR 34MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SULAR 8.5MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover SULAR 8.5MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in PA cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in PA cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in PA cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFAMYLON CREAM 85GM 4 OZ TUBE ![Compare how all Medicare Part D PDP plans in PA cover SULFAMYLON CREAM 85GM 4 OZ TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULFATRIM PEDIATRIC SUSP ![Compare how all Medicare Part D PDP plans in PA cover SULFATRIM PEDIATRIC SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in PA cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:8 /30Days |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:8 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:9 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in PA cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:9 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in PA cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $12.00 | Q:9 /30Days |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in PA cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in PA cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SURMONTIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SURMONTIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in PA cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:10 /30Days |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in PA cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | Q:10 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMBYAX 12-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SYMBYAX 12-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYMBYAX 12-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SYMBYAX 12-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYMBYAX 3MG-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SYMBYAX 3MG-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYMBYAX 6-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SYMBYAX 6-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYMBYAX 6-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover SYMBYAX 6-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in PA cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in PA cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | S |
SYNALGOS DC CAPSULES 16;356.4;MG;MG;MG; ![Compare how all Medicare Part D PDP plans in PA cover SYNALGOS DC CAPSULES 16;356.4;MG;MG;MG;.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 137MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 137MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $85.00 | None |