2011 Medicare Part D Plan Formulary Information |
WellCare Classic (PDP) (S5967-143-0)
Benefit Details
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The WellCare Classic (PDP) (S5967-143-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 6 which includes: PA WV
|
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 |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | Q:124 /31Days |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | Q:124 /31Days |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | Q:31 /31Days |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in WV cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | Q:60 /30Days |
SEROMYCIN CAPSULES 250MG ![Compare how all Medicare Part D PDP plans in WV cover SEROMYCIN CAPSULES 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | Q:93 /31Days |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WV cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WV cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in WV cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in WV 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) |
4 |
Specialty Tier |
25% | N/A | P Q:1 /30Days |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in WV cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WV cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WV cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in WV cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SODIUM BICARB INJ 8.4% ![Compare how all Medicare Part D PDP plans in WV cover SODIUM BICARB INJ 8.4%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM CHLORIDE INJECTION 3% 24X500ML BAG ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE INJECTION 3% 24X500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in WV cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in WV cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in WV cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SORIATANE 22.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SORIATANE 22.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in WV cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in WV cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in WV cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in WV cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | S Q:30 /30Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
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 WV cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in WV cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | P |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in WV cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in WV cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | Q:8 /31Days |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | Q:8 /31Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:9 /31Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:9 /31Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:9 /31Days |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SURMONTIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SURMONTIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P Q:31 /31Days |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P Q:31 /31Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P Q:31 /31Days |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in WV cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in WV cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |
SYMBYAX 12-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYMBYAX 12-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMBYAX 12-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYMBYAX 12-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P Q:31 /31Days |
SYMBYAX 3MG-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYMBYAX 3MG-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P Q:31 /31Days |
SYMBYAX 6-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYMBYAX 6-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P Q:31 /31Days |
SYMBYAX 6-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYMBYAX 6-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P Q:31 /31Days |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WV cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WV cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | P |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
25% | N/A | P |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 137MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 137MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic and Preferred Brand |
$40.00 | $100.00 | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Generic and Non-Preferred Brand |
$85.00 | $212.00 | None |