2011 Medicare Part D Plan Formulary Information |
Clarian Medicare Select Plus (HMO) (H7220-003-0)
Benefit Details
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The Clarian Medicare Select Plus (HMO) (H7220-003-0) Formulary Drugs Starting with the Letter P in Brown County, IN: CMS MA Region 13 which includes: IN
|
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PACERONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PACERONE 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PACERONE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PACERONE 400MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PACERONE 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA] ![Compare how all Medicare Part D PDP plans in IN cover PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA] ![Compare how all Medicare Part D PDP plans in IN cover PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA] ![Compare how all Medicare Part D PDP plans in IN cover PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA] ![Compare how all Medicare Part D PDP plans in IN cover PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA] ![Compare how all Medicare Part D PDP plans in IN cover PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAMELOR 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PAMELOR 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAMELOR 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PAMELOR 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAMELOR CAPSULES 10 ![Compare how all Medicare Part D PDP plans in IN cover PAMELOR CAPSULES 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAMELOR CAPSULES 75MG ![Compare how all Medicare Part D PDP plans in IN cover PAMELOR CAPSULES 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAMIDRONATE 60MG/10ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PAMIDRONATE 60MG/10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | P |
PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in IN cover PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | P |
PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in IN cover PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | P |
PAMINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAMINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAMINE FORTE 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAMINE FORTE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PANITUMUMAB 20 MG/ML INJECTABLE SOLUTION [VECTIBIX] ![Compare how all Medicare Part D PDP plans in IN cover PANITUMUMAB 20 MG/ML INJECTABLE SOLUTION [VECTIBIX].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PANRETIN 0.1% GEL 60GM TUBE ![Compare how all Medicare Part D PDP plans in IN cover PANRETIN 0.1% GEL 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PANTOPRAZOLE SODIUM 40MG TABLET DELAYED RELEASE 90 CRC BOT ![Compare how all Medicare Part D PDP plans in IN cover PANTOPRAZOLE SODIUM 40MG TABLET DELAYED RELEASE 90 CRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | S |
PARAFON FORTE DSC 500MG CPT ![Compare how all Medicare Part D PDP plans in IN cover PARAFON FORTE DSC 500MG CPT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PARCAINE 0.5% DROPS ![Compare how all Medicare Part D PDP plans in IN cover PARCAINE 0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PARLODEL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PARLODEL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PARLODEL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PARLODEL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PARNATE 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PARNATE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAROMOMYCIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PAROMOMYCIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE FILM COATED 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE FILM COATED 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE HCL 10MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE HCL 10MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE HCL TABLET 24 12.5MG ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE HCL TABLET 24 12.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAROXETINE HCL TABLET 24 25MG ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE HCL TABLET 24 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PAROXETINE TABLETS 30MG 90 BOT ![Compare how all Medicare Part D PDP plans in IN cover PAROXETINE TABLETS 30MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PASER GRANULES 4GM PACKET ![Compare how all Medicare Part D PDP plans in IN cover PASER GRANULES 4GM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PATADAY 0.2% DROPS ![Compare how all Medicare Part D PDP plans in IN cover PATADAY 0.2% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | S |
PATANOL 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover PATANOL 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | S |
PAXIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAXIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAXIL 10MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in IN cover PAXIL 10MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAXIL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAXIL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAXIL 30MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAXIL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PAXIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PAXIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAZOPANIB 200 MG ORAL TABLET [VOTRIENT] ![Compare how all Medicare Part D PDP plans in IN cover PAZOPANIB 200 MG ORAL TABLET [VOTRIENT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEDI-DRI TOPICAL POWDER ![Compare how all Medicare Part D PDP plans in IN cover PEDI-DRI TOPICAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PEDIAPRED 6.7MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in IN cover PEDIAPRED 6.7MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PEDIARIX SOLUTION INJECTION 25-25-10 10 X .5ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PEDIARIX SOLUTION INJECTION 25-25-10 10 X .5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PEDVAXHIB VACCINE VIAL ![Compare how all Medicare Part D PDP plans in IN cover PEDVAXHIB VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PEG-INTRON 100MCG KIT ![Compare how all Medicare Part D PDP plans in IN cover PEG-INTRON 100MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEG-INTRON REDIPEN 120MCG ![Compare how all Medicare Part D PDP plans in IN cover PEG-INTRON REDIPEN 120MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEG-INTRON REDIPEN 150MCG ![Compare how all Medicare Part D PDP plans in IN cover PEG-INTRON REDIPEN 150MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEG-INTRON REDIPEN 50MCG ![Compare how all Medicare Part D PDP plans in IN cover PEG-INTRON REDIPEN 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEG-INTRON REDIPEN 80MCG ![Compare how all Medicare Part D PDP plans in IN cover PEG-INTRON REDIPEN 80MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEGANONE 250MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PEGANONE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PEGASYS 180MCG/0.5ML CONV.PK ![Compare how all Medicare Part D PDP plans in IN cover PEGASYS 180MCG/0.5ML CONV.PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PEGASYS INJECTION ![Compare how all Medicare Part D PDP plans in IN cover PEGASYS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PENICILLIN G POTASSIUM FOR INJECTION ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN G POTASSIUM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN G PROCAINE 1200000UNT 2ML CTG ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN G PROCAINE 1200000UNT 2ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN G SODIUM FOR INJECTION 5000000UNT 1 VIAL ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN G SODIUM FOR INJECTION 5000000UNT 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN V POTASSIUM 250MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN V POTASSIUM 250MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN V POTASSIUM 250MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN V POTASSIUM 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN V POTASSIUM 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENICILLIN V POTASSIUM FOR ORAL SOLUTION CONCENTRATE 125MG 200ML BOT ![Compare how all Medicare Part D PDP plans in IN cover PENICILLIN V POTASSIUM FOR ORAL SOLUTION CONCENTRATE 125MG 200ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENLAC 8% SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover PENLAC 8% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PENTAM 300 INJ 300MG ![Compare how all Medicare Part D PDP plans in IN cover PENTAM 300 INJ 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENTASA 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IN cover PENTASA 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PENTASA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PENTASA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PENTAZOCINE/ACETAMIN TABLET ![Compare how all Medicare Part D PDP plans in IN cover PENTAZOCINE/ACETAMIN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENTAZOCINE/NALOXONE TABLET ![Compare how all Medicare Part D PDP plans in IN cover PENTAZOCINE/NALOXONE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENTOPAK 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover PENTOPAK 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PENTOSTATIN FOR INJECTION 10MG/VIAL ![Compare how all Medicare Part D PDP plans in IN cover PENTOSTATIN FOR INJECTION 10MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PENTOXIFYLLINE 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover PENTOXIFYLLINE 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PEPCID 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PEPCID 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PEPCID 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PEPCID 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERCOCET 10/325MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERCOCET 10/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERCOCET 10/650MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERCOCET 10/650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERCOCET 7.5/325MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERCOCET 7.5/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERCOCET 7.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERCOCET 7.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERCODAN TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERCODAN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERIOGARD 0.12% ORAL RINSE ![Compare how all Medicare Part D PDP plans in IN cover PERIOGARD 0.12% ORAL RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERIOSTAT DOXYCYCLINE HYCLATE TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PERIOSTAT DOXYCYCLINE HYCLATE TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERMETHRIN 5% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PERMETHRIN 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERPHENAZINE TABLETS 16MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PERPHENAZINE TABLETS 16MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERPHENAZINE TABLETS 4MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover PERPHENAZINE TABLETS 4MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERPHENAZINE TABLETS 8MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PERPHENAZINE TABLETS 8MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERPHENAZINE TABLETS USP 2MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PERPHENAZINE TABLETS USP 2MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PERSANTINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERSANTINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERSANTINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERSANTINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PERSANTINE 75MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PERSANTINE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PHENADOZ 12.5MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in IN cover PHENADOZ 12.5MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHENADOZ 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in IN cover PHENADOZ 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHENYTEK 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PHENYTEK 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PHENYTEK 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PHENYTEK 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT ![Compare how all Medicare Part D PDP plans in IN cover PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHENYTOIN SOD EXT 200 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover PHENYTOIN SOD EXT 200 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHENYTOIN SODIUM INJECTION 50MG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in IN cover PHENYTOIN SODIUM INJECTION 50MG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PHOSLO 667MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PHOSLO 667MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHOSPHOLINE IODIDE 0.125% ![Compare how all Medicare Part D PDP plans in IN cover PHOSPHOLINE IODIDE 0.125%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PHOTOFRIN 75MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover PHOTOFRIN 75MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PILOCARPINE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PILOCARPINE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PILOCARPINE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PILOCARPINE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PILOPINE HS 4% EYE GEL ![Compare how all Medicare Part D PDP plans in IN cover PILOPINE HS 4% EYE GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PINDOLOL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PINDOLOL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PINDOLOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PINDOLOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PIPERACILLIN 3GM VIAL ![Compare how all Medicare Part D PDP plans in IN cover PIPERACILLIN 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PIROXICAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PIROXICAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PIROXICAM 20MG CAPSULE (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover PIROXICAM 20MG CAPSULE (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PLAQUENIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PLAQUENIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PLAVIX 75MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PLAVIX 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PLAVIX TABLETS 300MG ![Compare how all Medicare Part D PDP plans in IN cover PLAVIX TABLETS 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PLETAL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PLETAL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PLETAL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PLETAL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PODOFILOX 0.5% TOPICAL TUBEX ![Compare how all Medicare Part D PDP plans in IN cover PODOFILOX 0.5% TOPICAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLY-DEX 0.1% SUSPENSION DROPS ![Compare how all Medicare Part D PDP plans in IN cover POLY-DEX 0.1% SUSPENSION DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLY-DEX 3.5-10K-.1 OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover POLY-DEX 3.5-10K-.1 OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYCIN-B 500-10KU/G OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover POLYCIN-B 500-10KU/G OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT) ![Compare how all Medicare Part D PDP plans in IN cover POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.00497 MEQ/ML / SODIUM BICARBONATE 1.43 MG/ ![Compare how all Medicare Part D PDP plans in IN cover POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.00497 MEQ/ML / SODIUM BICARBONATE 1.43 MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYETHYLENE GLYCOL 3350 59 MG/ML / POTASSIUM CHLORIDE 0.1 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML / ![Compare how all Medicare Part D PDP plans in IN cover POLYETHYLENE GLYCOL 3350 59 MG/ML / POTASSIUM CHLORIDE 0.1 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML /.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POLYETHYLENE GLYCOL 3350 60 MG/ML / POTASSIUM CHLORIDE 0.01 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML ![Compare how all Medicare Part D PDP plans in IN cover POLYETHYLENE GLYCOL 3350 60 MG/ML / POTASSIUM CHLORIDE 0.01 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1% ![Compare how all Medicare Part D PDP plans in IN cover POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POLYTRIM EYE DROP ![Compare how all Medicare Part D PDP plans in IN cover POLYTRIM EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PORTIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in IN cover PORTIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE 20MEQ/50ML SOL ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE 20MEQ/50ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE 40MEQ IN D5W LACT RNG ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE 40MEQ IN D5W LACT RNG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE TABLET ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE ER CAPSULES 10MEQ ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE ER CAPSULES 10MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE ER CPCR 8MEQ ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE ER CPCR 8MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE EXTENDED RELEASE TABLETS ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE EXTENDED RELEASE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CHLORIDE TABLET EXTENED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CHLORIDE TABLET EXTENED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CITRATE 10MEQ TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CITRATE 10MEQ TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
POTASSIUM CITRATE 5MEQ TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover POTASSIUM CITRATE 5MEQ TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAMIPEXOLE DIHYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PRAMIPEXOLE DIHYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRANDIN 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRANDIN 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRANDIN 1MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRANDIN 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRANDIN 2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRANDIN 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRASUGREL 10 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRASUGREL 10 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRASUGREL 5 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRASUGREL 5 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRAVACHOL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAVACHOL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRAVACHOL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAVACHOL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRAVACHOL 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAVACHOL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRAVACHOL 80MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRAVACHOL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRAVASTATIN SODIUM 20MG TABLET 500 BOT ![Compare how all Medicare Part D PDP plans in IN cover PRAVASTATIN SODIUM 20MG TABLET 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAVASTATIN SODIUM 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover PRAVASTATIN SODIUM 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAVASTATIN SODIUM 80MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IN cover PRAVASTATIN SODIUM 80MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAVASTATIN SODIUM TABLETS 10MG 90 BOT ![Compare how all Medicare Part D PDP plans in IN cover PRAVASTATIN SODIUM TABLETS 10MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAZOSIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PRAZOSIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAZOSIN HCL 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PRAZOSIN HCL 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRAZOSIN HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PRAZOSIN HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRECOSE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRECOSE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRECOSE TABLETS 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PRECOSE TABLETS 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRECOSE TABLETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover PRECOSE TABLETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRED FORTE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover PRED FORTE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PREDNICARBATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover PREDNICARBATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNICARBATE 1 MG/ML TOPICAL CREAM ![Compare how all Medicare Part D PDP plans in IN cover PREDNICARBATE 1 MG/ML TOPICAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR ![Compare how all Medicare Part D PDP plans in IN cover PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISOLONE SOD 1% EYE DROP ![Compare how all Medicare Part D PDP plans in IN cover PREDNISOLONE SOD 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in IN cover PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREDNISONE 5MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover PREDNISONE 5MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREFEST TABLET 30 EA ![Compare how all Medicare Part D PDP plans in IN cover PREFEST TABLET 30 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PRELONE 15MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in IN cover PRELONE 15MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PREMARIN 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMARIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMARIN 0.625MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 0.625MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMARIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMARIN 1.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 1.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMARIN 25MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN 25MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMARIN VAGINAL CREAM /APPL ![Compare how all Medicare Part D PDP plans in IN cover PREMARIN VAGINAL CREAM /APPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMPHASE 0.625/5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PREMPHASE 0.625/5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMPRO 0.3 MG-1.5 MG TABLET #28 EA ![Compare how all Medicare Part D PDP plans in IN cover PREMPRO 0.3 MG-1.5 MG TABLET #28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREMPRO 0.45-1.5 MG TABLET 28 EA ![Compare how all Medicare Part D PDP plans in IN cover PREMPRO 0.45-1.5 MG TABLET 28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRENATABS OBN TABLETS 200;1;150;MG;MG;MCG; 90 BOT ![Compare how all Medicare Part D PDP plans in IN cover PRENATABS OBN TABLETS 200;1;150;MG;MG;MCG; 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PREVACID CAPSULES DELAYED RELEASE 15 MG ![Compare how all Medicare Part D PDP plans in IN cover PREVACID CAPSULES DELAYED RELEASE 15 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREVACID CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in IN cover PREVACID CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PREVALITE POW 4GM ![Compare how all Medicare Part D PDP plans in IN cover PREVALITE POW 4GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREVIFEM TABLETS .035;.25MG;MG 28 BLPK ![Compare how all Medicare Part D PDP plans in IN cover PREVIFEM TABLETS .035;.25MG;MG 28 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PREZISTA TABLET 600MG ![Compare how all Medicare Part D PDP plans in IN cover PREZISTA TABLET 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREZISTA TABLET 75MG ![Compare how all Medicare Part D PDP plans in IN cover PREZISTA TABLET 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREZISTA TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PREZISTA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PREZISTA TABLETS 400MG 60 TABLETS BOT ![Compare how all Medicare Part D PDP plans in IN cover PREZISTA TABLETS 400MG 60 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRIFTIN 150MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRIFTIN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PRILOSEC 10MG CAPSULE DR ![Compare how all Medicare Part D PDP plans in IN cover PRILOSEC 10MG CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRILOSEC 20MG CAPSULE DR ![Compare how all Medicare Part D PDP plans in IN cover PRILOSEC 20MG CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRILOSEC 40MG CAPSULE DR ![Compare how all Medicare Part D PDP plans in IN cover PRILOSEC 40MG CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRIMIDONE 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PRIMIDONE 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRIMIDONE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover PRIMIDONE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PRINIVIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRINIVIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRINIVIL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRINIVIL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRINIVIL TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PRINIVIL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRINZIDE 10/12.5 TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRINZIDE 10/12.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRINZIDE 20/12.5 TABLET ![Compare how all Medicare Part D PDP plans in IN cover PRINZIDE 20/12.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PRISTIQ 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover PRISTIQ 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRISTIQ 50MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover PRISTIQ 50MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PRIVIGEN 10% VIAL ![Compare how all Medicare Part D PDP plans in IN cover PRIVIGEN 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PROAMATINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROAMATINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROAMATINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROAMATINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROAMATINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROAMATINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROBENECID 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROBENECID 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROBENECID/COLCHICINE TABLET S ![Compare how all Medicare Part D PDP plans in IN cover PROBENECID/COLCHICINE TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCARDIA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROCARDIA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROCARDIA XL 30MG TABLET (300 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROCARDIA XL 30MG TABLET (300 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROCARDIA XL 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover PROCARDIA XL 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROCARDIA XL 90MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover PROCARDIA XL 90MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN ![Compare how all Medicare Part D PDP plans in IN cover PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in IN cover PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCRIT 10000U/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT 10000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT 2000U/ML VIAL 6 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PROCRIT 3000U/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT 3000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PROCRIT 40000U/ML VIAL PR ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT 40000U/ML VIAL PR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PROCRIT 4000U/ML VIAL 25 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT 4000U/ML VIAL 25 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY ![Compare how all Medicare Part D PDP plans in IN cover PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PROCTO-PAK 1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PROCTO-PAK 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCTOCORT 1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PROCTOCORT 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROCTOCREAM-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PROCTOCREAM-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROCTOSOL-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PROCTOSOL-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCTOZONE-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in IN cover PROCTOZONE-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROGLYCEM 50MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in IN cover PROGLYCEM 50MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PROGRAF 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROGRAF 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROGRAF 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROGRAF 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROGRAF 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROGRAF 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROGRAF 5MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in IN cover PROGRAF 5MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROLASTIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROLASTIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROLEUKIN 22 MILLION UNITS VL ![Compare how all Medicare Part D PDP plans in IN cover PROLEUKIN 22 MILLION UNITS VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | P |
PROMACTA TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PROMACTA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | None |
PROMACTA TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PROMACTA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | None |
PROMACTA TABLETS 25 MG ![Compare how all Medicare Part D PDP plans in IN cover PROMACTA TABLETS 25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
30% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMETHAZINE HCL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HCL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE HCL 25MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HCL 25MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE HCL 6.25MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HCL 6.25MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHAZINE VC PLAIN 6.25-5MG 16 FL OZ BOT ![Compare how all Medicare Part D PDP plans in IN cover PROMETHAZINE VC PLAIN 6.25-5MG 16 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHEGAN 25MG SUPP ![Compare how all Medicare Part D PDP plans in IN cover PROMETHEGAN 25MG SUPP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETHEGAN 50MG SUPPOS ![Compare how all Medicare Part D PDP plans in IN cover PROMETHEGAN 50MG SUPPOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROMETRIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROMETRIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PROMETRIUM 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover PROMETRIUM 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPAFENONE HCL 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPAFENONE HCL 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPAFENONE HCL 225MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPAFENONE HCL 225MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPAFENONE HCL 300MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPAFENONE HCL 300MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPARACAINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover PROPARACAINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPINE 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover PROPINE 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PROPRANOLOL 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL 60MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL CAPSULES ER 120MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL CAPSULES ER 120MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL HCL CAPSULES ER 160MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL CAPSULES ER 160MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL CAPSULES ER 60MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL CAPSULES ER 60MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL CAPSULES ER 80MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL CAPSULES ER 80MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL TABLET USP 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL TABLET USP 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL HCL TABLET USP 40MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL HCL TABLET USP 40MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL/HCTZ 40/25 TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL/HCTZ 40/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPRANOLOL/HCTZ 80/25 TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPRANOLOL/HCTZ 80/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROPYLTHIOURACIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROPYLTHIOURACIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROQUAD VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROQUAD VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROSCAR TABLETS 5MG 30 BOT ![Compare how all Medicare Part D PDP plans in IN cover PROSCAR TABLETS 5MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROTONIX IV 40MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover PROTONIX IV 40MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROTOPIC 0.03% OINTMENT 100GM TUBE ![Compare how all Medicare Part D PDP plans in IN cover PROTOPIC 0.03% OINTMENT 100GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROTOPIC 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in IN cover PROTOPIC 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROTRIPTYLINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in IN cover PROTRIPTYLINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG ![Compare how all Medicare Part D PDP plans in IN cover PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PROVENTIL HFA INHALER 90MCG AE ![Compare how all Medicare Part D PDP plans in IN cover PROVENTIL HFA INHALER 90MCG AE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROVERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROVERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROVERA 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROVERA 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROVERA 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROVERA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROVIGIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROVIGIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROVIGIL 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PROVIGIL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $87.50 | None |
PROZAC 10MG PULVULE ![Compare how all Medicare Part D PDP plans in IN cover PROZAC 10MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROZAC 40MG PULVULE ![Compare how all Medicare Part D PDP plans in IN cover PROZAC 40MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PROZAC CAPSULES 20MG (2000 CT) ![Compare how all Medicare Part D PDP plans in IN cover PROZAC CAPSULES 20MG (2000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PULMICORT .25MG/2ML RESPULE ![Compare how all Medicare Part D PDP plans in IN cover PULMICORT .25MG/2ML RESPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PULMICORT 0.5MG/2ML RESPULE ![Compare how all Medicare Part D PDP plans in IN cover PULMICORT 0.5MG/2ML RESPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION ![Compare how all Medicare Part D PDP plans in IN cover PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | None |
PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in IN cover PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in IN cover PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PURINETHOL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PURINETHOL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$85.00 | $212.50 | P |
PYRAZINAMIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PYRAZINAMIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |
PYRIDOSTIGMINE BROMIDE 60MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover PYRIDOSTIGMINE BROMIDE 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.50 | $13.75 | None |