2011 Medicare Part D Plan Formulary Information |
Health Net Orange Option 1 (PDP) (S5678-056-0)
Sanctioned Plan
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The Health Net Orange Option 1 (PDP) (S5678-056-0) Formulary Drugs Starting with the Letter B in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
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 IA cover BACIIM POWDER FOR INJECTION SOLUTION 50000UNT/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BACITRACIN 500U/GM EYE OINT ![Compare how all Medicare Part D PDP plans in IA cover BACITRACIN 500U/GM EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in IA cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in IA cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BACLOFEN 20MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BACLOFEN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BACTROBAN 2% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BACTROBAN 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in IA cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BALZIVA 0.4-0.035 TABLET ![Compare how all Medicare Part D PDP plans in IA cover BALZIVA 0.4-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in IA cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:16 /1Days |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in IA cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:8 /1Days |
BARACLUDE 0.05MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IA cover BARACLUDE 0.05MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | 25% | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | 25% | None |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BENICAR 20MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENICAR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENICAR 40MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENICAR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENICAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENICAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENICAR HCT 20-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENICAR HCT 20-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENICAR HCT 40-25MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENICAR HCT 40-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENICAR HCT TABLET 12.5-40MG (30 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENICAR HCT TABLET 12.5-40MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BENTYL INJECTION 20MG/2ML AMP ![Compare how all Medicare Part D PDP plans in IA cover BENTYL INJECTION 20MG/2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BENZOYL PEROXIDE 0.05 MG/MG / CLINDAMYCIN 0.01 MG/MG TOPICAL GEL ![Compare how all Medicare Part D PDP plans in IA cover BENZOYL PEROXIDE 0.05 MG/MG / CLINDAMYCIN 0.01 MG/MG TOPICAL GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BENZTROPINE MES 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MES 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | 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 IA cover BENZTROPINE MES TABLET 1MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BENZTROPINE MES TABLET 2MG (1000 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MES TABLET 2MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BENZTROPINE MESYLATE INJECTION 2MG/2ML ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MESYLATE INJECTION 2MG/2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BENZYL ALCOHOL 50 ML/ML TOPICAL LOTION [ULESFIA] ![Compare how all Medicare Part D PDP plans in IA cover BENZYL ALCOHOL 50 ML/ML TOPICAL LOTION [ULESFIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in IA cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | S Q:5 /7Days |
BETA-VAL 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BETA-VAL 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE 0.0005 MG/MG AUGMENTED TOPICAL OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE 0.0005 MG/MG AUGMENTED TOPICAL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE DIPROPIONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DIPROPIONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE DIPROPIONATE LOTION 60ML ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DIPROPIONATE LOTION 60ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE DP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE DP 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE VA 0.1% LOTION ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VA 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAMETHASONE VA 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VA 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM ![Compare how all Medicare Part D PDP plans in IA cover BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | 25% | P |
BETAXOLOL HCL 0.5% EYE DROP ![Compare how all Medicare Part D PDP plans in IA cover BETAXOLOL HCL 0.5% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETAXOLOL TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover BETAXOLOL TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BETAXOLOL TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover BETAXOLOL TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
BETHANECHOL CHLORIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL CHLORIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETHANECHOL CHLORIDE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL CHLORIDE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETHANECHOL CHLORIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL CHLORIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
BETIMOL SOLUTION 2.5MG 5 ML BOT ![Compare how all Medicare Part D PDP plans in IA cover BETIMOL SOLUTION 2.5MG 5 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in IA cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BICALUTAMIDE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover BICALUTAMIDE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in IA cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BICNU INJECTION 100MG/VIL ![Compare how all Medicare Part D PDP plans in IA cover BICNU INJECTION 100MG/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BILTRICIDE 600MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BILTRICIDE 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in IA cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BLEPHAMIDE 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover BLEPHAMIDE 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:10 /10Days |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in IA cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
BONIVA 150MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BONIVA 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BONIVA 3MG/3ML SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover BONIVA 3MG/3ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BOOSTRIX INJECTION SUSPENSION 2.5UNT-5ML 5 X .5ML SYR ![Compare how all Medicare Part D PDP plans in IA cover BOOSTRIX INJECTION SUSPENSION 2.5UNT-5ML 5 X .5ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BOROFAIR SOL 2% OTIC ![Compare how all Medicare Part D PDP plans in IA cover BOROFAIR SOL 2% OTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BOTOX 100UNITS VIAL ![Compare how all Medicare Part D PDP plans in IA cover BOTOX 100UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | P |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in IA cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BROMOCRIPTINE MESYLATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BROMOCRIPTINE MESYLATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUDEPRION SR 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in IA cover BUDEPRION SR 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
BUDEPRION SR 150MG TABLET SA ![Compare how all Medicare Part D PDP plans in IA cover BUDEPRION SR 150MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BUDEPRION XL 300MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IA cover BUDEPRION XL 300MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | Q:1 /1Days |
BUDEPRION XL TABLETS 150MG 500 TABLETS BOT ![Compare how all Medicare Part D PDP plans in IA cover BUDEPRION XL TABLETS 150MG 500 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUDESONIDE 0.25 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE 0.25 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | P Q:4 /1Days |
BUDESONIDE 0.5 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE 0.5 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | P Q:4 /1Days |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BUMETANIDE 0.5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 0.5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUMETANIDE 1MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 1MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUMETANIDE 2MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 2MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUPHENYL 500MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPHENYL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | 25% | None |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in IA cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | 25% | None |
BUPRENEX 0.3MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IA cover BUPRENEX 0.3MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BUPROBAN ER TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROBAN ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL 150 MG TABLET SA ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL 150 MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BUPROPION HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:6 /1Days |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
BUPROPION HCL TABLET 100MG ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL TABLET 100MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
BUSPIRONE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
BUTALBITAL/CAFF/APAP/COD CP ![Compare how all Medicare Part D PDP plans in IA cover BUTALBITAL/CAFF/APAP/COD CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$75.00 | $188.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | None |
BYETTA 10MCG/0.04ML PEN INJ ![Compare how all Medicare Part D PDP plans in IA cover BYETTA 10MCG/0.04ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | P |
BYETTA 5MCG/0.02ML PEN INJ ![Compare how all Medicare Part D PDP plans in IA cover BYETTA 5MCG/0.02ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | 25% | P |
BYSTOLIC 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BYSTOLIC 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:4 /1Days |
BYSTOLIC 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BYSTOLIC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BYSTOLIC NEBIVOLOL HCL 2.5MG TABLET ORAL ![Compare how all Medicare Part D PDP plans in IA cover BYSTOLIC NEBIVOLOL HCL 2.5MG TABLET ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:1 /1Days |
BYSTOLIC TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover BYSTOLIC TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$37.00 | $74.00 | Q:2 /1Days |