2011 Medicare Part D Plan Formulary Information |
Triple-S Medicare Optimo Select (HMO) (HMO) (H4012-008-0)
Benefit Details
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The Triple-S Medicare Optimo Select (HMO) (HMO) (H4012-008-0) Formulary Drugs Starting with the Letter C in Coamo County, PR: CMS MA Region 0 which includes: PR
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CALCIPOTRIENE TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CALCIPOTRIENE TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /15Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in PR cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | Q:4 /30Days |
CALCITRIOL 0.25MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CALCITRIOL 0.25MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CALCITRIOL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CALCITRIOL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PR cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CALCIUM ACETATE CAPSULE 667 MG ![Compare how all Medicare Part D PDP plans in PR cover CALCIUM ACETATE CAPSULE 667 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CALCIUM CHLORIDE 0.0014 MEQ/ML / POTASSIUM CHLORIDE 0.004 MEQ/ML / SODIUM CHLORIDE 0.103 MEQ/ML / SO ![Compare how all Medicare Part D PDP plans in PR cover CALCIUM CHLORIDE 0.0014 MEQ/ML / POTASSIUM CHLORIDE 0.004 MEQ/ML / SODIUM CHLORIDE 0.103 MEQ/ML / SO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CAMPATH 30MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover CAMPATH 30MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CAMPRAL 333MG DOSE PAK ![Compare how all Medicare Part D PDP plans in PR cover CAMPRAL 333MG DOSE PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in PR cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CAPREOMYCIN 500 MG/ML INJECTABLE SOLUTION [CAPASTAT] ![Compare how all Medicare Part D PDP plans in PR cover CAPREOMYCIN 500 MG/ML INJECTABLE SOLUTION [CAPASTAT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL/HCTZ 25/15 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL/HCTZ 25/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL/HCTZ 25/25 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL/HCTZ 25/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CAPTOPRIL/HCTZ 50/15 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL/HCTZ 50/15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL/HCTZ 50/25 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CAPTOPRIL/HCTZ 50/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARAC CRE 0.5% ![Compare how all Medicare Part D PDP plans in PR cover CARAC CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in PR cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG ![Compare how all Medicare Part D PDP plans in PR cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG ![Compare how all Medicare Part D PDP plans in PR cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBAMAZEPINE ORAL SUSPENSION 200 MG ![Compare how all Medicare Part D PDP plans in PR cover CARBAMAZEPINE ORAL SUSPENSION 200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PR cover CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PR cover CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in PR cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARIMUNE NF 3GM VIAL ![Compare how all Medicare Part D PDP plans in PR cover CARIMUNE NF 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | P |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PR cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARVEDILOL 12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARVEDILOL 12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARVEDILOL 25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARVEDILOL 25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARVEDILOL 3.125MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARVEDILOL 3.125MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CARVEDILOL 6.25MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CARVEDILOL 6.25MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEENU 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CEENU 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEENU 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CEENU 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEENU 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CEENU 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFACLOR 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PR cover CEFACLOR 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFACLOR 375MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PR cover CEFACLOR 375MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFACLOR CAPSULES ![Compare how all Medicare Part D PDP plans in PR cover CEFACLOR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFACLOR CAPSULES ![Compare how all Medicare Part D PDP plans in PR cover CEFACLOR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in PR cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFADROXIL 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CEFADROXIL 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFAZOLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in PR cover CEFAZOLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFAZOLIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in PR cover CEFAZOLIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFEPIME HCL 2 GRAM VIAL ![Compare how all Medicare Part D PDP plans in PR cover CEFEPIME HCL 2 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL ![Compare how all Medicare Part D PDP plans in PR cover CEFEPIME INJ 1GM 20ML APX 10x1G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFPODOXIME PROXETIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CEFPODOXIME PROXETIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPROZIL 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEFPROZIL 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFPROZIL TABLETS 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover CEFPROZIL TABLETS 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFTAZIDIME FOR INJECTION 1GM/VIAL 1 SINGLE VIAL VIAL ![Compare how all Medicare Part D PDP plans in PR cover CEFTAZIDIME FOR INJECTION 1GM/VIAL 1 SINGLE VIAL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFTIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PR cover CEFTIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PR cover CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in PR cover CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CEFUROXIME 250MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CEFUROXIME 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PR cover CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFUROXIME AXETIL 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEFUROXIME AXETIL 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PR cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in PR cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CELLCEPT 200MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PR cover CELLCEPT 200MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CELONTIN 300MG KAPSEAL ![Compare how all Medicare Part D PDP plans in PR cover CELONTIN 300MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CEPHALEXIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CEPHALEXIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEPHALEXIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PR cover CEPHALEXIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEPHALEXIN CAPSULES 500MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CEPHALEXIN CAPSULES 500MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CEREDASE 80UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover CEREDASE 80UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CEREZYME INJ 200UNIT ![Compare how all Medicare Part D PDP plans in PR cover CEREZYME INJ 200UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CHANTIX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHANTIX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CHANTIX 1MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHANTIX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHANTIX STARTING MONTH PAK ![Compare how all Medicare Part D PDP plans in PR cover CHANTIX STARTING MONTH PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in PR cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLOROQUINE PH 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLOROQUINE PH 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in PR cover CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLOROTHIAZIDE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLOROTHIAZIDE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLOROTHIAZIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLOROTHIAZIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROMAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROMAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROMAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROMAZINE 25MG/ML AMP ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE 25MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROMAZINE HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROMAZINE HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROPAMIDE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROPAMIDE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORPROPAMIDE 250MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover CHLORPROPAMIDE 250MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORTHALIDONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CHLORTHALIDONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORTHALIDONE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover CHLORTHALIDONE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHLORZOXAZONE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CHLORZOXAZONE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CHORIONIC GONAD 10000U VIAL ![Compare how all Medicare Part D PDP plans in PR cover CHORIONIC GONAD 10000U VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CILOSTAZOL 50MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PR cover CILOSTAZOL 50MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in PR cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CIMETIDINE 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover CIMETIDINE 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CIPRO (10%) SUS 500MG/5 ![Compare how all Medicare Part D PDP plans in PR cover CIPRO (10%) SUS 500MG/5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CIPRO (5%) SUS 250MG/5 ![Compare how all Medicare Part D PDP plans in PR cover CIPRO (5%) SUS 250MG/5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | Q:8 /15Days |
CIPROFLOXACIN 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CIPROFLOXACIN 400 MG/40 ML VL ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN 400 MG/40 ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CIPROFLOXACIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CIPROFLOXACIN ER 1000MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN ER 1000MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | Q:14 /30Days |
CIPROFLOXACIN ER 500MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN ER 500MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | Q:28 /30Days |
CIPROFLOXACIN HCL 0.3% DROPS ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN HCL 0.3% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN TABLETS 750MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover CIPROFLOXACIN TABLETS 750MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CITALOPRAM HBR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CITALOPRAM HBR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL ![Compare how all Medicare Part D PDP plans in PR cover CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in PR cover CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CITOLOPRAM HBR 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CITOLOPRAM HBR 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLARITHROMYCIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CLARITHROMYCIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLARITHROMYCIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CLARITHROMYCIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PR cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLEOCIN PED SOL 75MG/5ML ![Compare how all Medicare Part D PDP plans in PR cover CLEOCIN PED SOL 75MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG ![Compare how all Medicare Part D PDP plans in PR cover CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CLINDAMYCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLINDAMYCIN HYDROCHLORIDE CAPSULES ![Compare how all Medicare Part D PDP plans in PR cover CLINDAMYCIN HYDROCHLORIDE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in PR cover CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in PR cover CLINDAMYCIN PHOSPHATE VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLINIMIX 2.75%/5% INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 2.75%/5% INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX 4.25/10 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 4.25/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CLINIMIX 4.25/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 4.25/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CLINIMIX 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CLINIMIX 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX 5/15 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 5/15 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 2.75/10 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 2.75/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 5/25 SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 5/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINIMIX E 5%/15% INJECTION 2000ML BAG ![Compare how all Medicare Part D PDP plans in PR cover CLINIMIX E 5%/15% INJECTION 2000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CLINISOL 15% SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLINISOL 15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PR cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOBETASOL 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CLOBETASOL 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PR cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOBETASOL PROPIONATE CRM 0.05% 15GM ![Compare how all Medicare Part D PDP plans in PR cover CLOBETASOL PROPIONATE CRM 0.05% 15GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in PR cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLONIDINE PATCH 0.1MG/DAY ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE PATCH 0.1MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLONIDINE PATCH 0.2MG/DAY ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE PATCH 0.2MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE PATCH 0.3MG/DAY ![Compare how all Medicare Part D PDP plans in PR cover CLONIDINE PATCH 0.3MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in PR cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in PR cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL ![Compare how all Medicare Part D PDP plans in PR cover CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOZAPINE 100 MG DISINTEGRATING TABLET [FAZACLO] ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 100 MG DISINTEGRATING TABLET [FAZACLO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CLOZAPINE 100 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 100 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOZAPINE 12.5 MG DISINTEGRATING TABLET [FAZACLO] ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 12.5 MG DISINTEGRATING TABLET [FAZACLO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CLOZAPINE 25 MG DISINTEGRATING TABLET [FAZACLO] ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 25 MG DISINTEGRATING TABLET [FAZACLO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PR cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
COARTEM 20MG-120MG ![Compare how all Medicare Part D PDP plans in PR cover COARTEM 20MG-120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | Q:24 /365Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLCHICINE 0.6 MG ORAL TABLET [COLCRYS] ![Compare how all Medicare Part D PDP plans in PR cover COLCHICINE 0.6 MG ORAL TABLET [COLCRYS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in PR cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
COLESTIPOL HCL 5G GRANULES ![Compare how all Medicare Part D PDP plans in PR cover COLESTIPOL HCL 5G GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
COLISTIMETHATE 150MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover COLISTIMETHATE 150MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in PR cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | Q:30 /15Days |
COMBIVENT INHALER ![Compare how all Medicare Part D PDP plans in PR cover COMBIVENT INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | Q:29 /30Days |
COMBIVIR TABLETS ![Compare how all Medicare Part D PDP plans in PR cover COMBIVIR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
COMTAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover COMTAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PR cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CONDYLOX GEL 0.5% 3.5 GM CRTN ![Compare how all Medicare Part D PDP plans in PR cover CONDYLOX GEL 0.5% 3.5 GM CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in PR cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CORTISONE ACETATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CORTISONE ACETATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in PR cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CRESTOR 20MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CRESTOR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CRESTOR 40MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover CRESTOR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | None |
CRIXIVAN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CRIXIVAN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
CRIXIVAN 333MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CRIXIVAN 333MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
CRIXIVAN 400MG CAPSULE (120 CT) ![Compare how all Medicare Part D PDP plans in PR cover CRIXIVAN 400MG CAPSULE (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
CROMOLYN NEBULIZER SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover CROMOLYN NEBULIZER SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CUPRIMINE CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover CUPRIMINE CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | None |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PR cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CYCLOSPORINE 50MG/ML AMP ![Compare how all Medicare Part D PDP plans in PR cover CYCLOSPORINE 50MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in PR cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | P |
CYKLOKAPRON 100MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PR cover CYKLOKAPRON 100MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$5.00 | $15.00 | P |
CYMBALTA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYMBALTA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYMBALTA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYMBALTA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | S Q:30 /30Days |
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in PR cover CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | S Q:30 /30Days |
CYPROHEPTADINE HCL 4 MG ![Compare how all Medicare Part D PDP plans in PR cover CYPROHEPTADINE HCL 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in PR cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in PR cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$15.00 | $45.00 | P |