2011 Medicare Part D Plan Formulary Information |
PMC Max (HMO) (H4004-050-0)
Benefit Details
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The PMC Max (HMO) (H4004-050-0) Formulary Drugs Starting with the Letter A in Mayaguez County, PR: CMS MA Region 0 which includes: PR
|
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ABELCENT INJECTION SUSPENSION 5MG/ML ![Compare how all Medicare Part D PDP plans in PR cover ABELCENT INJECTION SUSPENSION 5MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ABILIFY 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY 15MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY 1MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 1MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S |
ABILIFY 20MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY 2MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY 30MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY 5MG TABLET (OTSUKA) ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY 5MG TABLET (OTSUKA).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ABILIFY DISCMELT 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY DISCMELT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
ABILIFY DISCMELT 15MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY DISCMELT 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABILIFY INJ 9.75MG ![Compare how all Medicare Part D PDP plans in PR cover ABILIFY INJ 9.75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S |
ACARBOSE 100MG TABLET S ![Compare how all Medicare Part D PDP plans in PR cover ACARBOSE 100MG TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACARBOSE 50MG TABLET S ![Compare how all Medicare Part D PDP plans in PR cover ACARBOSE 50MG TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACARBOSE TABLETS ![Compare how all Medicare Part D PDP plans in PR cover ACARBOSE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACEBUTOLOL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ACEBUTOLOL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACEBUTOLOL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ACEBUTOLOL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE ![Compare how all Medicare Part D PDP plans in PR cover ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD ![Compare how all Medicare Part D PDP plans in PR cover ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETASOL HC SOLUTION 10ML 10 ML BOT ![Compare how all Medicare Part D PDP plans in PR cover ACETASOL HC SOLUTION 10ML 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAZOLAMIDE 125MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACETAZOLAMIDE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAZOLAMIDE 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACETAZOLAMIDE 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACETIC ACID 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in PR cover ACETIC ACID 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACTEMRA INJECTION 200MG/10ML ![Compare how all Medicare Part D PDP plans in PR cover ACTEMRA INJECTION 200MG/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ACTHIB VACCINE VIAL 10-24UNT/5ML ![Compare how all Medicare Part D PDP plans in PR cover ACTHIB VACCINE VIAL 10-24UNT/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ACTICIN 5% CREAM ![Compare how all Medicare Part D PDP plans in PR cover ACTICIN 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACTIMMUNE SOLUTION FOR INJECTION 100MCG ![Compare how all Medicare Part D PDP plans in PR cover ACTIMMUNE SOLUTION FOR INJECTION 100MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ACTOPLUS MET 15MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACTOPLUS MET 15MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:90 /30Days |
ACTOPLUS MET 15MG/850MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACTOPLUS MET 15MG/850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTOS 15MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACTOS 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ACTOS 30MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACTOS 30MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ACTOS 45MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACTOS 45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA ![Compare how all Medicare Part D PDP plans in PR cover ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ACYCLOVIR 200MG CAPSULE (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACYCLOVIR 200MG CAPSULE (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACYCLOVIR 200MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in PR cover ACYCLOVIR 200MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACYCLOVIR 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ACYCLOVIR 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACYCLOVIR 800 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PR cover ACYCLOVIR 800 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ACYCLOVIR SODIUM 500MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover ACYCLOVIR SODIUM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in PR cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ADAGEN 250U/ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover ADAGEN 250U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA] ![Compare how all Medicare Part D PDP plans in PR cover ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ADAPALENE CREAM ![Compare how all Medicare Part D PDP plans in PR cover ADAPALENE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
ADAPALENE GEL ![Compare how all Medicare Part D PDP plans in PR cover ADAPALENE GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
ADCIRCA TABLETS 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in PR cover ADCIRCA TABLETS 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P Q:60 /30Days |
ADVAIR DISKU MIS 100/50 ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR DISKU MIS 100/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:120 /30Days |
ADVAIR DISKU MIS 250/50 ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR DISKU MIS 250/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:120 /30Days |
ADVAIR DISKU MIS 500/50 ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR DISKU MIS 500/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:120 /30Days |
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:24 /30Days |
ADVAIR HFA INHALER 230;21MCG;MCG ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR HFA INHALER 230;21MCG;MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:24 /30Days |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in PR cover ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P Q:24 /30Days |
AFEDITAB CR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in PR cover AFEDITAB CR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFEDITAB CR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in PR cover AFEDITAB CR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AFINITOR TABLETS ![Compare how all Medicare Part D PDP plans in PR cover AFINITOR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AFINITOR TABLETS ![Compare how all Medicare Part D PDP plans in PR cover AFINITOR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AFINITOR TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in PR cover AFINITOR TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AGGRENOX 25-200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AGGRENOX 25-200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AK-CON 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PR cover AK-CON 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AKTOB 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in PR cover AKTOB 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBENZA 200MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ALBENZA 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ALBUTEROL SULFATE 4MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE 4MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBUTEROL SULFATE 8MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE 8MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBUTEROL SULFATE SOLUTION FOR INHALATION ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE SOLUTION FOR INHALATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBUTEROL SULFATE TABLET 2MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL SULFATE TABLET 2MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALBUTEROL TABLET 4MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover ALBUTEROL TABLET 4MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PR cover ALCLOMETASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PR cover ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALDURAZYME 2.9MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover ALDURAZYME 2.9MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ALENDRONATE SODIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ALENDRONATE SODIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:30 /30Days |
ALENDRONATE SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ALENDRONATE SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:30 /30Days |
ALENDRONATE SODIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ALENDRONATE SODIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:30 /30Days |
ALENDRONATE SODIUM TABLET 35MG 20 CRTN ![Compare how all Medicare Part D PDP plans in PR cover ALENDRONATE SODIUM TABLET 35MG 20 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:5 /35Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALENDRONATE SODIUM TABLETS 70 MG ![Compare how all Medicare Part D PDP plans in PR cover ALENDRONATE SODIUM TABLETS 70 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:5 /35Days |
ALIMTA 500MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover ALIMTA 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ALINIA 100MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover ALINIA 100MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ALINIA 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ALINIA 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ALLOPURINOL TABLET 300MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover ALLOPURINOL TABLET 300MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALLOPURINOL TABLETS ![Compare how all Medicare Part D PDP plans in PR cover ALLOPURINOL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ALPHA-1-PROTEINASE INHIBITOR,HUMAN 16 MG/ML INJECTABLE SOLUTION [ARALAST] ![Compare how all Medicare Part D PDP plans in PR cover ALPHA-1-PROTEINASE INHIBITOR,HUMAN 16 MG/ML INJECTABLE SOLUTION [ARALAST].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ALPHAGAN P 0.1% DROPS ![Compare how all Medicare Part D PDP plans in PR cover ALPHAGAN P 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AMANTADINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMANTADINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMANTADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMANTADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMANTADINE HCL 50 MG/ 5 ML SYRUP ![Compare how all Medicare Part D PDP plans in PR cover AMANTADINE HCL 50 MG/ 5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMBISOME 50MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMBISOME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
AMCINONIDE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PR cover AMCINONIDE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMCINONIDE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in PR cover AMCINONIDE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMCINONIDE 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in PR cover AMCINONIDE 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM ![Compare how all Medicare Part D PDP plans in PR cover AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AMIFOSTINE FOR INJECTION 500MG/VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMIFOSTINE FOR INJECTION 500MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMILORIDE HCL W/HCTZ 5MG-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMINOPHYLLINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMINOPHYLLINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMINOPHYLLINE 200MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMINOPHYLLINE 200MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD ![Compare how all Medicare Part D PDP plans in PR cover AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN 5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN 7%-ELECTROLYTE SOL ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 7%-ELECTROLYTE SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN HBC INJECTION SULFITE FREE 7% ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN HBC INJECTION SULFITE FREE 7%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 3.5% IN D25W IV ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 3.5% IN D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 3.5% IN D5W IV ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 3.5% IN D5W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN II 3.5% M/D5W IV ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 3.5% M/D5W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 3.5% W/ELEC DEX ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 3.5% W/ELEC DEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 4.25% IN D10W ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 4.25% IN D10W.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 4.25% IN D20W ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 4.25% IN D20W.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 4.25% W/ELEC DW ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 4.25% W/ELEC DW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 4.25%-D25W IV ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 4.25%-D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 5% IN D25W IV ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 5% IN D25W IV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 8.5% ELECTROLYT ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 8.5% ELECTROLYT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN II 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN II 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN M 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN M 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN PF INJECTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN PF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5% ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN-HF 8% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN-HF 8% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMINOSYN-PF 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover AMINOSYN-PF 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AMIODARONE HCL 400MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMIODARONE HCL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMIODARONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in PR cover AMIODARONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITIZA 8MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMITIZA 8MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AMITRIP/CDP 25-10 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/CDP 25-10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIP/PERPHEN 10-2 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/PERPHEN 10-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIP/PERPHEN 10-4 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/PERPHEN 10-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIP/PERPHEN 25-2 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/PERPHEN 25-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIP/PERPHEN 25-4 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/PERPHEN 25-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIP/PERPHEN 50-4 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIP/PERPHEN 50-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL 150 MG TAB ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL 25MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL 75MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover AMITRIPTYLINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE 2.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMMONIUM CHLORIDE 5 MEQ/ML ![Compare how all Medicare Part D PDP plans in PR cover AMMONIUM CHLORIDE 5 MEQ/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AMMONIUM LACTATE 12% CREAM ![Compare how all Medicare Part D PDP plans in PR cover AMMONIUM LACTATE 12% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in PR cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMNESTEEM 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMNESTEEM 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMNESTEEM 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMNESTEEM 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMNESTEEM 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMNESTEEM 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-K CLV 500-125 MG TAB ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-K CLV 500-125 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOXAPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN 125MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 125MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 200MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 200MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 400MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 400MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN 875MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN 875MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT) ![Compare how all Medicare Part D PDP plans in PR cover AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMPHOTEC FOR INJECTION 50MG/VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMPHOTEC FOR INJECTION 50MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AMPHOTERICIN B FOR INJECTION 50 MG ![Compare how all Medicare Part D PDP plans in PR cover AMPHOTERICIN B FOR INJECTION 50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
AMPICILLIN CAPSULES 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN CAPSULES 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AMPICILLIN POWDER FOR INJECTION 1 GM/ML ![Compare how all Medicare Part D PDP plans in PR cover AMPICILLIN POWDER FOR INJECTION 1 GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
ANADROL-50 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ANADROL-50 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ANAGRELIDE HCL 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ANAGRELIDE HCL 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ANAGRELIDE HCL 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ANAGRELIDE HCL 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ANASTROZOLE TABLETS ![Compare how all Medicare Part D PDP plans in PR cover ANASTROZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ANCOBON 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ANCOBON 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ANCOBON 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ANCOBON 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ANTABUSE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ANTABUSE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANTABUSE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ANTABUSE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
APAP-CAFFEINE-DIHYDROCODE TAB 30 EA ![Compare how all Medicare Part D PDP plans in PR cover APAP-CAFFEINE-DIHYDROCODE TAB 30 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
APOKYN 30 MG/3 ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in PR cover APOKYN 30 MG/3 ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
APRACLONIDINE 5 MG/ML OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover APRACLONIDINE 5 MG/ML OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PR cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT ![Compare how all Medicare Part D PDP plans in PR cover APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ARCALYST INJECTION 220MG/VIAL ![Compare how all Medicare Part D PDP plans in PR cover ARCALYST INJECTION 220MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ARICEPT 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARICEPT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
ARICEPT 5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARICEPT 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARICEPT ODT 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARICEPT ODT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
ARICEPT ODT 5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARICEPT ODT 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
ARIMIDEX 1MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover ARIMIDEX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ARIXTRA 10MG SYRINGE ![Compare how all Medicare Part D PDP plans in PR cover ARIXTRA 10MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ARIXTRA 2.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in PR cover ARIXTRA 2.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
ARIXTRA 5MG SYRINGE ![Compare how all Medicare Part D PDP plans in PR cover ARIXTRA 5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ARIXTRA 7.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in PR cover ARIXTRA 7.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
AROMASIN 25MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AROMASIN 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ASACOL 400MG TABLET EC ![Compare how all Medicare Part D PDP plans in PR cover ASACOL 400MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
ASCOMP W/CODEINE 30-50-325 CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover ASCOMP W/CODEINE 30-50-325 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS] ![Compare how all Medicare Part D PDP plans in PR cover ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS] ![Compare how all Medicare Part D PDP plans in PR cover ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
ASTEPRO 0.15% NASAL SPRAY 30 ML ![Compare how all Medicare Part D PDP plans in PR cover ASTEPRO 0.15% NASAL SPRAY 30 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | Q:60 /30Days |
ATENOLOL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ATENOLOL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ATENOLOL TABLET USP 50MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ATENOLOL TABLET USP 50MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ATENOLOL TABLETS USP 100MG 1 BLPK ![Compare how all Medicare Part D PDP plans in PR cover ATENOLOL TABLETS USP 100MG 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ATGAM 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PR cover ATGAM 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
ATRIPLA TABLET 600MG/200MG ![Compare how all Medicare Part D PDP plans in PR cover ATRIPLA TABLET 600MG/200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
ATROPINE 0.025 MG / DIPHENOXYLATE 2.5 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PR cover ATROPINE 0.025 MG / DIPHENOXYLATE 2.5 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in PR cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | Q:26 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in PR cover ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
AVALIDE 150-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVALIDE 150-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVALIDE 300-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVALIDE 300-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVALIDE 300-25MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVALIDE 300-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVANDAMET 2MG/1000MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDAMET 2MG/1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDAMET 2MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDAMET 2MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDAMET 4MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDAMET 4MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDAMET TABLET 4-1000MG ![Compare how all Medicare Part D PDP plans in PR cover AVANDAMET TABLET 4-1000MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDARYL 4MG/1MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDARYL 4MG/1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDARYL 4MG/2MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDARYL 4MG/2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDARYL 4MG/4MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDARYL 4MG/4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVANDARYL 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDARYL 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVANDARYL 8MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDARYL 8MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVANDIA 2MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVANDIA 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDIA 4MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PR cover AVANDIA 4MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:60 /30Days |
AVANDIA 8MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PR cover AVANDIA 8MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVAPRO 150MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVAPRO 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVAPRO 300MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVAPRO 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVAPRO 75MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PR cover AVAPRO 75MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | S Q:30 /30Days |
AVASTIN 100MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover AVASTIN 100MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AVELOX 400MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVELOX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | Q:10 /10Days |
AVELOX ABC PACK 400MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVELOX ABC PACK 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in PR cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AVONEX ADMIN PACK 30MCG SYR ![Compare how all Medicare Part D PDP plans in PR cover AVONEX ADMIN PACK 30MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P Q:4 /28Days |
AVONEX ADMIN PACK 30MCG VL ![Compare how all Medicare Part D PDP plans in PR cover AVONEX ADMIN PACK 30MCG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P Q:4 /28Days |
AZASAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AZASAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AZASAN 75MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AZASAN 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | P |
AZATHIOPRINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AZATHIOPRINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | P |
AZELASTINE 137 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PR cover AZELASTINE 137 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:60 /30Days |
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:30 /5Days |
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:68 /5Days |
AZITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:8 /7Days |
AZITHROMYCIN 500MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN 500MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /4Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AZITHROMYCIN TABLETS ![Compare how all Medicare Part D PDP plans in PR cover AZITHROMYCIN TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in PR cover AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$25.00 | $50.00 | Q:10 /30Days |
AZTREONAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in PR cover AZTREONAM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |