2011 Medicare Part D Plan Formulary Information |
CIGNA Medicare Rx Plan One (PDP) (S5617-068-0)
Benefit Details
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The CIGNA Medicare Rx Plan One (PDP) (S5617-068-0) Formulary Drugs Starting with the Letter B in CMS PDP Region 14 which includes: OH
|
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACIIM POWDER FOR INJECTION SOLUTION 50000UNT/VIAL ![Compare how all Medicare Part D PDP plans in OH cover BACIIM POWDER FOR INJECTION SOLUTION 50000UNT/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BACITRACIN 500U/GM EYE OINT ![Compare how all Medicare Part D PDP plans in OH cover BACITRACIN 500U/GM EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in OH cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in OH cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BACLOFEN 20MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BACLOFEN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in OH cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BALZIVA 0.4-0.035 TABLET ![Compare how all Medicare Part D PDP plans in OH cover BALZIVA 0.4-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in OH cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | P |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in OH cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BARACLUDE 0.05MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover BARACLUDE 0.05MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | 25% | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | 25% | None |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENZTROPINE MES TABLET 1MG (1000 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENZTROPINE MES TABLET 1MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENZTROPINE MES TABLET 2MG (1000 CT) ![Compare how all Medicare Part D PDP plans in OH cover BENZTROPINE MES TABLET 2MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BENZTROPINE MESYLATE INJECTION 2MG/2ML ![Compare how all Medicare Part D PDP plans in OH cover BENZTROPINE MESYLATE INJECTION 2MG/2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BENZTROPINE MESYLATE TABLETS ![Compare how all Medicare Part D PDP plans in OH cover BENZTROPINE MESYLATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETA-VAL 0.1% CREAM ![Compare how all Medicare Part D PDP plans in OH cover BETA-VAL 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE CREAM USP ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE CREAM USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE LOTION ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE LOTION 60ML ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE LOTION 60ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE DIPROPIONATE OINTMENT AUGMENTED ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DIPROPIONATE OINTMENT AUGMENTED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE DP 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE DP 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE VA 0.1% LOTION ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE VA 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE VALERATE CREAM USP ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE VALERATE CREAM USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in OH cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM ![Compare how all Medicare Part D PDP plans in OH cover BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | 25% | P |
BETAXOLOL HCL 0.5% EYE DROP ![Compare how all Medicare Part D PDP plans in OH cover BETAXOLOL HCL 0.5% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETHANECHOL CHLORICDE TABLET ![Compare how all Medicare Part D PDP plans in OH cover BETHANECHOL CHLORICDE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETHANECHOL CHLORIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BETHANECHOL CHLORIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETHANECHOL CHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in OH cover BETHANECHOL CHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in OH cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETIMOL SOLUTION 2.5MG 5 ML BOT ![Compare how all Medicare Part D PDP plans in OH cover BETIMOL SOLUTION 2.5MG 5 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in OH cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BICALUTAMIDE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in OH cover BICALUTAMIDE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in OH cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in OH cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in OH cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in OH cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in OH cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | None |
BICNU INJECTION 100MG/VIL ![Compare how all Medicare Part D PDP plans in OH cover BICNU INJECTION 100MG/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | P |
BILTRICIDE 600MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BILTRICIDE 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in OH cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in OH cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | 25% | P |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in OH cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Generic/Non-Preferred Brand |
$73.00 | $182.50 | None |
BONIVA 150MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BONIVA 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:1 /30Days |
BONIVA 3MG/3ML SYRINGE ![Compare how all Medicare Part D PDP plans in OH cover BONIVA 3MG/3ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | P Q:3 /90Days |
BOOSTRIX INJECTION ![Compare how all Medicare Part D PDP plans in OH cover BOOSTRIX INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BOROFAIR SOL 2% OTIC ![Compare how all Medicare Part D PDP plans in OH cover BOROFAIR SOL 2% OTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in OH cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BROMOCRIPTINE MESYLATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BROMOCRIPTINE MESYLATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BUDEPRION SR 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in OH cover BUDEPRION SR 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
BUDEPRION SR 150MG TABLET SA ![Compare how all Medicare Part D PDP plans in OH cover BUDEPRION SR 150MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
BUDEPRION XL 300MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in OH cover BUDEPRION XL 300MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days |
BUDEPRION XL TABLETS 150MG 500 TABLETS BOT ![Compare how all Medicare Part D PDP plans in OH cover BUDEPRION XL TABLETS 150MG 500 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days |
BUDESONIDE 0.25 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in OH cover BUDESONIDE 0.25 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in OH cover BUDESONIDE 0.5 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | P |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUMETANIDE 0.5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in OH cover BUMETANIDE 0.5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUMETANIDE 1MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in OH cover BUMETANIDE 1MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUMETANIDE 2MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in OH cover BUMETANIDE 2MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUPHENYL 500MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPHENYL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in OH cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in OH cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUPRENORPHINE 2 MG SUBLINGUAL TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPRENORPHINE 2 MG SUBLINGUAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BUPRENORPHINE 8 MG SUBLINGUAL TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPRENORPHINE 8 MG SUBLINGUAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | None |
BUPROBAN ER TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPROBAN ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
BUPROPION HCL 150 MG TABLET SA ![Compare how all Medicare Part D PDP plans in OH cover BUPROPION HCL 150 MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
BUPROPION HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPROPION HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in OH cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL TABLET 100MG ![Compare how all Medicare Part D PDP plans in OH cover BUPROPION HCL TABLET 100MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in OH cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in OH cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUSPIRONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in OH cover BUSPIRONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUTALBITAL/CAFF/APAP/COD CP ![Compare how all Medicare Part D PDP plans in OH cover BUTALBITAL/CAFF/APAP/COD CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in OH cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | Q:5 /30Days |
BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic/Preferred Brand |
$3.00 | $7.50 | None |
BYETTA 10MCG/0.04ML PEN INJ ![Compare how all Medicare Part D PDP plans in OH cover BYETTA 10MCG/0.04ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:3 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BYETTA 5MCG/0.02ML PEN INJ ![Compare how all Medicare Part D PDP plans in OH cover BYETTA 5MCG/0.02ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:3 /30Days |
BYSTOLIC 10MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BYSTOLIC 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:120 /30Days |
BYSTOLIC 5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover BYSTOLIC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:90 /30Days |
BYSTOLIC NEBIVOLOL HCL 2.5MG TABLET ORAL ![Compare how all Medicare Part D PDP plans in OH cover BYSTOLIC NEBIVOLOL HCL 2.5MG TABLET ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:90 /30Days |
BYSTOLIC TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in OH cover BYSTOLIC TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic/Preferred Brand |
$30.00 | $75.00 | Q:60 /30Days |