2011 Medicare Part D Plan Formulary Information |
MedicareRx Rewards Plus (PDP) (S5960-156-0)
Benefit Details
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The MedicareRx Rewards Plus (PDP) (S5960-156-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SAIZEN 5MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SAIZEN 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SAIZEN 8.8MG CLICK.EASY CARTG ![Compare how all Medicare Part D PDP plans in IA cover SAIZEN 8.8MG CLICK.EASY CARTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in IA cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P Q:4 /28Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in IA cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | P |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | P |
SANDIMMUNE 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IA cover SANDIMMUNE 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | P |
SANDOSTATIN 0.05MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN 0.05MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN 0.1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN 0.1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN 0.2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN 0.2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SANDOSTATIN 0.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN 0.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in IA cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IA cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IA cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IA cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in IA cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:1 /365Days |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IA cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SAXAGLIPTIN 2.5 MG ORAL TABLET [ONGLYZA] ![Compare how all Medicare Part D PDP plans in IA cover SAXAGLIPTIN 2.5 MG ORAL TABLET [ONGLYZA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAXAGLIPTIN 5 MG ORAL TABLET [ONGLYZA] ![Compare how all Medicare Part D PDP plans in IA cover SAXAGLIPTIN 5 MG ORAL TABLET [ONGLYZA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in IA cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK ![Compare how all Medicare Part D PDP plans in IA cover SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:30 /30Days |
SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK ![Compare how all Medicare Part D PDP plans in IA cover SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:120 /30Days |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in IA cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SEROMYCIN CAPSULES 250MG ![Compare how all Medicare Part D PDP plans in IA cover SEROMYCIN CAPSULES 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:90 /30Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:90 /30Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:90 /30Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:120 /30Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:120 /30Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:90 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in IA cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:90 /30Days |
SEROSTIM 4MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SEROSTIM 4MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SEROSTIM 5MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SEROSTIM 5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SEROSTIM 6MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SEROSTIM 6MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IA cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:90 /30Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:60 /30Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IA cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:60 /30Days |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in IA cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:300 /30Days |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in IA cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in IA cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in IA cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IA cover SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IA cover SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in IA cover SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:60 /30Days |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IA cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IA cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in IA cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P Q:1 /28Days |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IA cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | Q:30 /30Days |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in IA cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | Q:30 /30Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IA cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | Q:30 /30Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IA cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | Q:30 /30Days |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in IA cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IA cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IA cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in IA cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM BICARB INJ 8.4% ![Compare how all Medicare Part D PDP plans in IA cover SODIUM BICARB INJ 8.4%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM CHLORIDE INJECTION 3% 24X500ML BAG ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CHLORIDE INJECTION 3% 24X500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SODIUM LACTATE 1/6MOLAR INJ ![Compare how all Medicare Part D PDP plans in IA cover SODIUM LACTATE 1/6MOLAR INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in IA cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in IA cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in IA cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:28 /28Days |
SOLU CORTEF INJECTION ![Compare how all Medicare Part D PDP plans in IA cover SOLU CORTEF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOLU CORTEF INJECTION 100 MG/VIAL ![Compare how all Medicare Part D PDP plans in IA cover SOLU CORTEF INJECTION 100 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SOLU MEDROL 125 MG AOV 25, 125MG/2ML ![Compare how all Medicare Part D PDP plans in IA cover SOLU MEDROL 125 MG AOV 25, 125MG/2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SOLU MEDROL FOR INJECTION 40 MG/ML ![Compare how all Medicare Part D PDP plans in IA cover SOLU MEDROL FOR INJECTION 40 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SOLU MEDROL FOR INJECTION 500 MG/ML ![Compare how all Medicare Part D PDP plans in IA cover SOLU MEDROL FOR INJECTION 500 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SOLU-MEDROL 2000MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SOLU-MEDROL 2000MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM ![Compare how all Medicare Part D PDP plans in IA cover SOMATROPIN INJECTION KIT 5.8MG/1.14ML 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SORIATANE 22.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SORIATANE 22.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in IA cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in IA cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IA cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IA cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IA cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IA cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in IA cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTALOL HYDROCHLORIDE INJECTION 15MG/ML ![Compare how all Medicare Part D PDP plans in IA cover SOTALOL HYDROCHLORIDE INJECTION 15MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in IA cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:30 /30Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IA cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in IA cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in IA cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in IA cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:28 /28Days |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
STADOL 2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover STADOL 2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:240 /30Days |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in IA cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in IA cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in IA cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in IA cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in IA cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT ![Compare how all Medicare Part D PDP plans in IA cover STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
STAVZOR 125MG CPDR ![Compare how all Medicare Part D PDP plans in IA cover STAVZOR 125MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | Q:60 /30Days |
STAVZOR 250MG CPDR ![Compare how all Medicare Part D PDP plans in IA cover STAVZOR 250MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | Q:60 /30Days |
STAVZOR 500MG CPDR ![Compare how all Medicare Part D PDP plans in IA cover STAVZOR 500MG CPDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P Q:1 /28Days |
STELARA 45 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover STELARA 45 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P Q:1 /28Days |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P Q:1 /28Days |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in IA cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | P |
STERILE VANCOMYCIN HYDROCHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in IA cover STERILE VANCOMYCIN HYDROCHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | P |
STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in IA cover STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | P |
STIMATE 1.5MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IA cover STIMATE 1.5MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in IA cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | P |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in IA cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in IA cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in IA cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in IA cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in IA cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULFATRIM PEDIATRIC SUSP ![Compare how all Medicare Part D PDP plans in IA cover SULFATRIM PEDIATRIC SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Drugs |
$4.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IA cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in IA cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | Q:4 /30Days |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in IA cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Injectable Drugs |
33% | 33% | Q:4 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in IA cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:9 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in IA cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:9 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in IA cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Non-Preferred Generic Drugs |
$7.00 | $10.50 | Q:9 /30Days |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in IA cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in IA cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in IA cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | Q:14 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SURMONTIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SURMONTIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Preferred Brand Drugs |
$85.00 | $212.50 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in IA cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:11 /30Days |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in IA cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | Q:11 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in IA cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in IA cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IA cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 Specialty Tier Drugs |
33% | N/A | P |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 137MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 137MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in IA cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Preferred Brand Drugs |
$43.00 | $107.50 | None |