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2011 Medicare Part D and Medicare Advantage Plan Formulary Browser

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CVS Caremark Value (PDP) (S5601-002-0)
Tier 1 (1750)
Tier 2 (813)
Tier 3 (57)
Tier 4 (210)

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M N O P Q R S T U V W X Y Z 0-9 
2011 Medicare Part D Plan Formulary Information
CVS Caremark Value (PDP) (S5601-002-0)
Benefit Details           
The CVS Caremark Value (PDP) (S5601-002-0)
Formulary Drugs Starting with the Letter C

in CMS PDP Region 01 which includes: ME NH
Drugs Starting with Letter C

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
CABERGOLINE 0.5 MG TABLET   1 Generic Drugs $5.00$7.50None
CALCIPOTRIENE OINTMENT   1 Generic Drugs $5.00$7.50None
CALCIPOTRIENE TOPICAL SOLUTION   1 Generic Drugs $5.00$7.50None
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY   1 Generic Drugs $5.00$7.50None
CALCITRIOL 0.25MCG CAPSULE   1 Generic Drugs $5.00$7.50P
CALCITRIOL 0.5MCG CAPSULE   1 Generic Drugs $5.00$7.50P
CALCITRIOL 1MCG/ML SOLUTION ORAL   1 Generic Drugs $5.00$7.50P
CALCITRIOL 2 MCG/ML VIAL   2 Preferred Brand Drugs $45.00$101.25P
CALCITRIOL INJECTION SOLUTION 1MCG 50 X 01ML AMP   1 Generic Drugs $5.00$7.50P
CALCIUM ACETATE CAPSULE 667 MG   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CALCIUM CHLORIDE 0.0014 MEQ/ML / POTASSIUM CHLORIDE 0.004 MEQ/ML / SODIUM CHLORIDE 0.103 MEQ/ML / SO   1 Generic Drugs $5.00$7.50None
CAMILA 0.35MG TABLET   1 Generic Drugs $5.00$7.50None
CAMPATH 30MG/ML VIAL   2 Preferred Brand Drugs $45.00$101.25P
CAMPRAL 333MG DOSE PAK   2 Preferred Brand Drugs $45.00$101.25P
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX   2 Preferred Brand Drugs $45.00$101.25None
CANCIDAS IV 50MG VIAL   2 Preferred Brand Drugs $45.00$101.25P
CANCIDAS IV 70MG VIAL   2 Preferred Brand Drugs $45.00$101.25P
CAPREOMYCIN 500 MG/ML INJECTABLE SOLUTION [CAPASTAT]   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CAPTOPRIL 100MG TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL 12.5MG TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL 25MG TABLET   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CAPTOPRIL 50MG TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL/HCTZ 25/15 TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL/HCTZ 25/25 TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL/HCTZ 50/15 TABLET   1 Generic Drugs $5.00$7.50None
CAPTOPRIL/HCTZ 50/25 TABLET   1 Generic Drugs $5.00$7.50None
CARAC CRE 0.5%   2 Preferred Brand Drugs $45.00$101.25None
CARAFATE SUS 1GM/10ML   2 Preferred Brand Drugs $45.00$101.25None
CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG   1 Generic Drugs $5.00$7.50None
CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG   1 Generic Drugs $5.00$7.50None
CARBAMAZEPINE ORAL SUSPENSION 200 MG   1 Generic Drugs $5.00$7.50None
CARBAMAZEPINE TABLET CHEWABLE 100MG (100 CT)   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARBAMAZEPINE TABLET USP 200MG (1000 CT)   1 Generic Drugs $5.00$7.50None
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT   1 Generic Drugs $5.00$7.50None
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT   1 Generic Drugs $5.00$7.50None
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT   1 Generic Drugs $5.00$7.50None
CARBIDOPA-LEVODOPA 25MG-100MG TABLET SA   1 Generic Drugs $5.00$7.50None
CARBIDOPA-LEVODOPA 50MG-200MG TABLET SA   1 Generic Drugs $5.00$7.50None
CARBIDOPA/LEVO 10/100 TABLET   1 Generic Drugs $5.00$7.50None
CARBIDOPA/LEVO 25/100 TABLET   1 Generic Drugs $5.00$7.50None
CARBIDOPA/LEVO 25/250 TABLET   1 Generic Drugs $5.00$7.50None
CARBOPLATIN INJECTION   1 Generic Drugs $5.00$7.50P
CARDIZEM CD 360MG CAPSULE SR 24 HR   2 Preferred Brand Drugs $45.00$101.25None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARISOPRODOL TABLET USP 350MG (100 CT)   1 Generic Drugs $5.00$7.50None
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT   1 Generic Drugs $5.00$7.50None
CARTIA XT 120MG CAPSULE SA   1 Generic Drugs $5.00$7.50None
CARTIA XT 180MG CAPSULE SA   1 Generic Drugs $5.00$7.50None
CARTIA XT 240MG CAPSULE SA   1 Generic Drugs $5.00$7.50None
CARTIA XT 300MG CAPSULE SR 24 HR   1 Generic Drugs $5.00$7.50None
CARVEDILOL 12.5MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CARVEDILOL 25MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CARVEDILOL 3.125MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CARVEDILOL 6.25MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CAYSTON KIT   4 Specialty Tier Drugs 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEENU 100MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CEENU 10MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CEENU 40MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CEFACLOR 250MG/5ML ORAL SUSP   1 Generic Drugs $5.00$7.50None
CEFACLOR 375MG/5ML ORAL SUSP   1 Generic Drugs $5.00$7.50None
CEFACLOR CAPSULES   1 Generic Drugs $5.00$7.50None
CEFACLOR CAPSULES   1 Generic Drugs $5.00$7.50None
CEFACLOR ER 500MG TABLET SR 12HR   2 Preferred Brand Drugs $45.00$101.25None
CEFACLOR POWDER FOR ORAL SUSPENSION USP 125MG 75ML BOT   1 Generic Drugs $5.00$7.50None
CEFADROXIL 1G TABLET   1 Generic Drugs $5.00$7.50None
CEFADROXIL 500MG CAPSULE   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFADROXIL 500MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Generic Drugs $5.00$7.50None
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Generic Drugs $5.00$7.50None
CEFAZOLIN 1 GM VIAL   1 Generic Drugs $5.00$7.50P
CEFAZOLIN 1GM/D5W BAG   2 Preferred Brand Drugs $45.00$101.25P
CEFAZOLIN 20GM BULK VIAL   1 Generic Drugs $5.00$7.50P
CEFAZOLIN FOR INJECTION   1 Generic Drugs $5.00$7.50P
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Generic Drugs $5.00$7.50None
CEFDINIR CAPSULES 300MG (60 CT)   1 Generic Drugs $5.00$7.50None
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT)   1 Generic Drugs $5.00$7.50None
CEFEPIME HCL 2 GRAM VIAL   1 Generic Drugs $5.00$7.50P
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL   1 Generic Drugs $5.00$7.50P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFOTAXIME FOR INJECTION   1 Generic Drugs $5.00$7.50None
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL   1 Generic Drugs $5.00$7.50None
CEFOTAXIME FOR INJECTION 2GM 25 VIAL   1 Generic Drugs $5.00$7.50None
CEFOTAXIME FOR INJECTION 500MG 10 VIAL   1 Generic Drugs $5.00$7.50P
CEFOXITIN 180 MG/ML INJECTABLE SOLUTION   1 Generic Drugs $5.00$7.50P
CEFOXITIN 95 MG/ML INJECTABLE SOLUTION   1 Generic Drugs $5.00$7.50P
CEFOXITIN FOR INJECTION SOLUTION   1 Generic Drugs $5.00$7.50P
CEFPODOXIME PROXETIL 200MG TABLET   1 Generic Drugs $5.00$7.50None
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT)   1 Generic Drugs $5.00$7.50None
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 100MG 50ML BOT   1 Generic Drugs $5.00$7.50None
CEFPODOXIME PROXETIL FOR ORAL SUSPENSION 50MG 50ML BOT   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFPROZIL 250MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Generic Drugs $5.00$7.50None
CEFPROZIL FOR ORAL SUSPENSION 125MG/5ML 75ML BOT   1 Generic Drugs $5.00$7.50None
CEFPROZIL TABLETS 500MG 100 BOT   1 Generic Drugs $5.00$7.50None
CEFTRIAXONE 10GM VIAL   1 Generic Drugs $5.00$7.50P
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL   1 Generic Drugs $5.00$7.50P
CEFTRIAXONE FOR INJECTION 500MG BOX OF 10 VIALGL   1 Generic Drugs $5.00$7.50P
CEFUROXIME 250MG TABLET   1 Generic Drugs $5.00$7.50None
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Generic Drugs $5.00$7.50None
CEFUROXIME AXETIL 500MG TABLET (20 CT)   1 Generic Drugs $5.00$7.50None
CEFUROXIME FOR INJECTION   1 Generic Drugs $5.00$7.50P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFUROXIME FOR INJECTION   1 Generic Drugs $5.00$7.50P
CEFUROXIME FOR INJECTION AND DEXTROSE INJECTION   2 Preferred Brand Drugs $45.00$101.25None
CELEBREX 100MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25P
CELEBREX 200MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25P
CELEBREX 400MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25P
CELEBREX 50MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25P
CELLCEPT 200MG/ML ORAL SUSP   2 Preferred Brand Drugs $45.00$101.25P
CELLCEPT 500MG TABLET   2 Preferred Brand Drugs $45.00$101.25P
CELLCEPT CAPSULES 250MG (500 CT)   2 Preferred Brand Drugs $45.00$101.25P
CELONTIN 300MG KAPSEAL   2 Preferred Brand Drugs $45.00$101.25None
CEPHALEXIN 250MG CAPSULE   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEPHALEXIN 250MG/5ML ORAL SUSP   1 Generic Drugs $5.00$7.50None
CEPHALEXIN CAPSULES 500MG (500 CT)   1 Generic Drugs $5.00$7.50None
CEPHALEXIN POWDER FOR SUSPENSION ORAL USP 125MG 200ML BOT   1 Generic Drugs $5.00$7.50None
CEREZYME INJ 200UNIT   4 Specialty Tier Drugs 25%N/AP
CESIA 7 DAYS X 3 TABLET   1 Generic Drugs $5.00$7.50None
CETIRIZINE HCL 5MG/5ML   1 Generic Drugs $5.00$7.50None
CHANTIX 0.5MG TABLET   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CHANTIX 1MG TABLET   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CHANTIX STARTING MONTH PAK   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH   1 Generic Drugs $5.00$7.50None
CHLOROQUINE PH 500MG TABLET   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT)   1 Generic Drugs $5.00$7.50None
CHLOROTHIAZIDE 250MG TABLET   1 Generic Drugs $5.00$7.50None
CHLOROTHIAZIDE 500MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORPROMAZINE 100MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORPROMAZINE 10MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORPROMAZINE 25MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORPROMAZINE 25MG/ML AMP   2 Preferred Brand Drugs $45.00$101.25None
CHLORPROMAZINE 50MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORPROMAZINE HCL 200MG TABLET   1 Generic Drugs $5.00$7.50None
CHLORTHALIDONE 25MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CHLORTHALIDONE 50MG TABLET (1000 CT)   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHLORZOXAZONE 500MG TABLET   1 Generic Drugs $5.00$7.50None
CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION   1 Generic Drugs $5.00$7.50None
CHORIONIC GONAD 10000U VIAL   1 Generic Drugs $5.00$7.50P
CICLOPIROX 0.77% CREAM   1 Generic Drugs $5.00$7.50None
CICLOPIROX 0.77% TOPICAL SUSPENSION   1 Generic Drugs $5.00$7.50None
CICLOPIROX 1% SHAMPOO   1 Generic Drugs $5.00$7.50None
CICLOPIROX GEL   1 Generic Drugs $5.00$7.50None
CILOSTAZOL 50MG TABLET (60 CT)   1 Generic Drugs $5.00$7.50None
CILOSTAZOL TABLET 100MG (60 CT)   1 Generic Drugs $5.00$7.50None
CILOXAN 0.3% OINTMENT   2 Preferred Brand Drugs $45.00$101.25None
CIMETIDINE 150MG/ML VIAL   1 Generic Drugs $5.00$7.50P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CIMETIDINE 200MG TABLET   1 Generic Drugs $5.00$7.50None
CIMETIDINE HCL 300MG/5ML SOL   1 Generic Drugs $5.00$7.50None
CIMETIDINE TABLETS   1 Generic Drugs $5.00$7.50None
CIMETIDINE TABLETS   1 Generic Drugs $5.00$7.50None
CIMETIDINE TABLETS USP   1 Generic Drugs $5.00$7.50None
CIMZIA 200 MG/ML SYRINGE KIT   4 Specialty Tier Drugs 25%N/AP
CIMZIA KIT   4 Specialty Tier Drugs 25%N/AP
CIPRO (10%) SUS 500MG/5   2 Preferred Brand Drugs $45.00$101.25None
CIPRO (5%) SUS 250MG/5   2 Preferred Brand Drugs $45.00$101.25None
CIPROFLOXACIN 250MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN 400 MG/40 ML VL   1 Generic Drugs $5.00$7.50P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CIPROFLOXACIN 500MG TABLET   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN ER 1000MG TABLET (30 CT)   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN ER 500MG TABLET (30 CT)   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN HCL 0.3% DROPS   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN HCL 100MG TABLET   1 Generic Drugs $5.00$7.50None
CIPROFLOXACIN TABLETS 750MG 100 BOT   1 Generic Drugs $5.00$7.50None
CISPLATIN 1 MG/ML INJECTABLE SOLUTION   1 Generic Drugs $5.00$7.50P
CITALOPRAM HBR 20 MG TABLET   1 Generic Drugs $5.00$7.50Q:45
/30Days
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL   1 Generic Drugs $5.00$7.50None
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT   1 Generic Drugs $5.00$7.50None
CITOLOPRAM HBR 10MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50Q:45
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLADRIBINE 1MG/ML VIAL   1 Generic Drugs $5.00$7.50P
CLARAVIS 10MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLARAVIS 20MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLARAVIS 30MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLARAVIS 40MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLARITHROMYCIN 250MG TABLET   1 Generic Drugs $5.00$7.50None
CLARITHROMYCIN 500MG TABLET   1 Generic Drugs $5.00$7.50None
CLARITHROMYCIN ER 500MG TABLET (60 CT)   1 Generic Drugs $5.00$7.50Q:60
/30Days
CLARITHROMYCIN FOR ORAL SUSPENSION   1 Generic Drugs $5.00$7.50Q:400
/10Days
CLARITHROMYCIN FOR ORAL SUSPENSION   1 Generic Drugs $5.00$7.50None
CLEMASTINE FUM 2.68MG TABLET   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLEMASTINE FUMARATE SYRUP   1 Generic Drugs $5.00$7.50None
CLEOCIN 100MG VAGINAL OVULE   2 Preferred Brand Drugs $45.00$101.25None
CLEOCIN HCL 75MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CLEOCIN PED SOL 75MG/5ML   2 Preferred Brand Drugs $45.00$101.25None
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG   2 Preferred Brand Drugs $45.00$101.25None
CLINDAMYCIN 150MG/ML ADDVAN   1 Generic Drugs $5.00$7.50P
CLINDAMYCIN HCL 150MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLINDAMYCIN HYDROCHLORIDE CAPSULES   1 Generic Drugs $5.00$7.50None
CLINDAMYCIN PHOSP 1% LOTION   1 Generic Drugs $5.00$7.50None
CLINDAMYCIN PHOSPHATE 1% SOLUTION NON-ORAL   1 Generic Drugs $5.00$7.50None
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX   1 Generic Drugs $5.00$7.50None
CLINDAMYCIN PHOSPHATE VAGINAL CREAM   1 Generic Drugs $5.00$7.50None
CLINIMIX 2.75%/5% INJECTION 1000ML BAG   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 4.25/10 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 4.25/20 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 4.25/25 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 4.25/5 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 5/15 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 5/20 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 2.75/10 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLINIMIX E 2.75/5 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 4.25/25 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 4.25/5 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 5/20 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 5/25 SOLUTION   2 Preferred Brand Drugs $45.00$101.25P
CLINIMIX E 5%/15% INJECTION 2000ML BAG   2 Preferred Brand Drugs $45.00$101.25P
CLINISOL 15% SOLUTION   1 Generic Drugs $5.00$7.50P
CLOBETASOL 0.05% OINTMENT   1 Generic Drugs $5.00$7.50None
CLOBETASOL 0.05% SOLUTION   1 Generic Drugs $5.00$7.50None
CLOBETASOL E 0.05% CREAM   1 Generic Drugs $5.00$7.50None
CLOBETASOL PROPIONATE 0.05% FOAM   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLOBETASOL PROPIONATE CRM 0.05% 15GM   1 Generic Drugs $5.00$7.50None
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE   1 Generic Drugs $5.00$7.50None
CLOMIPRAMINE HCL 25MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLOMIPRAMINE HCL 50MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLOMIPRAMINE HCL 75MG CAPSULE   1 Generic Drugs $5.00$7.50None
CLONIDINE HCL 0.2MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CLONIDINE HCL TABLET 0.1MG (500 CT)   1 Generic Drugs $5.00$7.50None
CLONIDINE HCL TABLET 0.3MG (100 CT)   1 Generic Drugs $5.00$7.50None
CLONIDINE PATCH 0.1MG/DAY   1 Generic Drugs $5.00$7.50None
CLONIDINE PATCH 0.2MG/DAY   1 Generic Drugs $5.00$7.50None
CLONIDINE PATCH 0.3MG/DAY   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLOTRIMAZOLE 1% CREAM   1 Generic Drugs $5.00$7.50None
CLOTRIMAZOLE 10MG TROCHE   1 Generic Drugs $5.00$7.50None
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL   1 Generic Drugs $5.00$7.50None
CLOZAPINE 100 MG DISINTEGRATING TABLET [FAZACLO]   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CLOZAPINE 100 MG ORAL TABLET   1 Generic Drugs $5.00$7.50None
CLOZAPINE 12.5 MG DISINTEGRATING TABLET [FAZACLO]   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CLOZAPINE 200MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CLOZAPINE 25 MG DISINTEGRATING TABLET [FAZACLO]   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25P
CLOZAPINE 25MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
CLOZAPINE 50MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CO-GESIC 5/500 TABLET   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COARTEM 20MG-120MG   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25None
COLCHICINE 0.6 MG ORAL TABLET [COLCRYS]   3 Non-Preferred Generic and Non-Preferred Brand Drugs $95.00$261.25Q:60
/30Days
COLESTIPOL HCL 1G TABLET   1 Generic Drugs $5.00$7.50None
COLESTIPOL HCL 5G GRANULES   1 Generic Drugs $5.00$7.50None
COLISTIMETHATE 150MG VIAL   1 Generic Drugs $5.00$7.50P
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE   2 Preferred Brand Drugs $45.00$101.25None
COLOCORT 100MG ENEMA   1 Generic Drugs $5.00$7.50None
COMBIGAN 0.2%-0.5% DROPS   2 Preferred Brand Drugs $45.00$101.25None
COMBIPATCH 0.05/0.14MG PTCH   2 Preferred Brand Drugs $45.00$101.25None
COMBIPATCH 0.05/0.25MG PTCH   2 Preferred Brand Drugs $45.00$101.25None
COMBIVENT INHALER   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COMBIVIR TABLETS   2 Preferred Brand Drugs $45.00$101.25None
COMPRO 25MG SUPPOSITORY   1 Generic Drugs $5.00$7.50None
COMTAN 200MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COMVAX VACCINE VIAL   2 Preferred Brand Drugs $45.00$101.25P
CONSTULOSE 10GM/15ML SYRUP   1 Generic Drugs $5.00$7.50None
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN   4 Specialty Tier Drugs 25%N/AP
COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR   2 Preferred Brand Drugs $45.00$101.25None
COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR   2 Preferred Brand Drugs $45.00$101.25None
COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR   2 Preferred Brand Drugs $45.00$101.25None
COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR   2 Preferred Brand Drugs $45.00$101.25None
CORTISONE ACETATE 25MG TABLET (100 CT)   1 Generic Drugs $5.00$7.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CORTOMYCIN EAR SOLUTION   1 Generic Drugs $5.00$7.50None
CORTOMYCIN EAR SUSPENSION   1 Generic Drugs $5.00$7.50None
COSMEGEN 0.5MG VIAL   2 Preferred Brand Drugs $45.00$101.25P
COUMADIN 10MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 1MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 2.5MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 2MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 3MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 4MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 5MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
COUMADIN 6MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COUMADIN 7.5MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT   2 Preferred Brand Drugs $45.00$101.25None
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT   2 Preferred Brand Drugs $45.00$101.25None
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT   2 Preferred Brand Drugs $45.00$101.25None
CRESTOR 10MG TABLET   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
CRESTOR 20MG TABLET   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
CRESTOR 40MG TABLET   2 Preferred Brand Drugs $45.00$101.25None
CRESTOR 5MG TABLET   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
CRIXIVAN 100MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CRIXIVAN 200MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CRIXIVAN 333MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CRIXIVAN 400MG CAPSULE (120 CT)   2 Preferred Brand Drugs $45.00$101.25None
CROMOLYN NEBULIZER SOLUTION   1 Generic Drugs $5.00$7.50P Q:240
/30Days
CROMOLYN SODIUM 4% 40MG 10ML BOT   1 Generic Drugs $5.00$7.50None
CUBICIN 500MG VIAL   4 Specialty Tier Drugs 25%N/AP
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT)   1 Generic Drugs $5.00$7.50None
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT)   1 Generic Drugs $5.00$7.50None
CYCLOPHOSPHAMIDE 25MG TABLET   1 Generic Drugs $5.00$7.50P
CYCLOPHOSPHAMIDE 50MG TABLET   1 Generic Drugs $5.00$7.50P
CYCLOSPORINE 100MG CAPSULE   1 Generic Drugs $5.00$7.50P
CYCLOSPORINE 100MG CAPSULE   1 Generic Drugs $5.00$7.50P
CYCLOSPORINE 25MG CAPSULE   1 Generic Drugs $5.00$7.50P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYCLOSPORINE 50MG CAPSULE   1 Generic Drugs $5.00$7.50P
CYCLOSPORINE 50MG/ML AMP   1 Generic Drugs $5.00$7.50P
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT   1 Generic Drugs $5.00$7.50P
CYKLOKAPRON 100MG/ML AMPUL   2 Preferred Brand Drugs $45.00$101.25None
CYMBALTA 20MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
CYMBALTA 60MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT)   2 Preferred Brand Drugs $45.00$101.25Q:30
/30Days
CYPROHEPTADINE HCL 4 MG   1 Generic Drugs $5.00$7.50None
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL   1 Generic Drugs $5.00$7.50None
CYSTADANE POWDER FOR ORAL SOLUTION 180GM   2 Preferred Brand Drugs $45.00$101.25None
CYSTAGON 150MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYSTAGON 50MG CAPSULE   2 Preferred Brand Drugs $45.00$101.25None
CYTARABINE 20MG/ML VIAL   1 Generic Drugs $5.00$7.50P
CYTARABINE 500MG VIAL   1 Generic Drugs $5.00$7.50P

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D CVS Caremark Value (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $(2840)) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, on the 2011 Humana Walmart-Preferred Rx Plan the pricing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2011 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.