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2011 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

BravoRx (PDP) (S5998-013-0)
Tier 1 (741)
Tier 2 (1029)
Tier 3 (859)
Tier 4 (36)
Tier 5 (183)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2011 Medicare Part D Plan Formulary Information
BravoRx (PDP) (S5998-013-0)
Benefit Details           
The BravoRx (PDP) (S5998-013-0)
Formulary Drugs Starting with the Letter T

in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter T

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
TACROLIMUS 0.5 MG ORAL CAPSULE   2 Tier 2 25%25%P
TACROLIMUS 1 MG ORAL CAPSULE   2 Tier 2 25%25%P
TACROLIMUS 5 MG ORAL CAPSULE   2 Tier 2 25%25%P
TAMIFLU 30MG CAPSULE   3 Tier 3 25%25%Q:112
/365Days
TAMIFLU 45MG CAPSULE   3 Tier 3 25%25%Q:56
/365Days
TAMIFLU 75MG CAPSULE UD   3 Tier 3 25%25%Q:56
/365Days
TAMIFLU ORAL SUSPENSION   3 Tier 3 25%25%None
TAMOXIFEN CITRATE 20MG TABLET (30 CT)   2 Tier 2 25%25%None
TAMOXIFEN CITRATE TABLETS 10MG 180 BOT   2 Tier 2 25%25%None
TAMSULOSIN HCL 0.4 MG CAPSULE   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TARCEVA 100MG TABLET   5 Tier 5 25%25%P Q:90
/90Days
TARCEVA 150MG TABLET   5 Tier 5 25%25%P Q:90
/90Days
TARCEVA 25MG TABLET   5 Tier 5 25%25%P Q:180
/90Days
TARGRETIN 1% GEL 60GM TUBE   3 Tier 3 25%25%None
TARGRETIN 75MG (100 CT)   3 Tier 3 25%25%None
TASIGNA 200MG CAPSULE 28 BLPK   5 Tier 5 25%25%Q:120
/30Days
TASMAR 100MG TABLET   3 Tier 3 25%25%None
TAXOTERE 80MG/2ML VIAL   5 Tier 5 25%25%P
TAZICEF 1GM VIAL   3 Tier 3 25%25%None
TAZICEF 2GM ADD-VANTAGE   3 Tier 3 25%25%None
TAZICEF 6GM/100ML VIAL   3 Tier 3 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TAZORAC 0.05% CREAM   3 Tier 3 25%25%None
TAZORAC 0.05% GEL   3 Tier 3 25%25%None
TAZORAC 0.1% CREAM   3 Tier 3 25%25%None
TAZORAC 0.1% GEL   3 Tier 3 25%25%None
TAZTIA DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES   2 Tier 2 25%25%None
TAZTIA DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES   2 Tier 2 25%25%None
TAZTIA DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES   2 Tier 2 25%25%None
TAZTIA XT 240MG CAPSULE SA   2 Tier 2 25%25%None
TAZTIA XT 360MG CAPSULE SA   2 Tier 2 25%25%None
TEGRETOL XR TABLETS 100MG 100 BOT   3 Tier 3 25%25%None
TERAZOSIN HCL 10MG CAPSULE   1 Tier 1 25%25%Q:180
/90Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TERAZOSIN HCL 1MG CAPSULE   1 Tier 1 25%25%Q:180
/90Days
TERAZOSIN HCL 2MG CAPSULE   1 Tier 1 25%25%Q:180
/90Days
TERAZOSIN HCL 5MG CAPSULE   1 Tier 1 25%25%Q:180
/90Days
TERBINAFINE HCL 250MG TABLET   1 Tier 1 25%25%Q:30
/30Days
TERBUTALINE SULF 1MG/ML VL   2 Tier 2 25%25%None
TERBUTALINE SULF 2.5MG TABLET   2 Tier 2 25%25%None
TERBUTALINE SULFATE 5MG TABLET   2 Tier 2 25%25%None
TERCONAZOLE 0.4% CREAM WITH APPLICATOR   2 Tier 2 25%25%None
TERCONAZOLE 80MG SUPPOSITORY VAGINAL   2 Tier 2 25%25%None
TERCONAZOLE VAGINAL CREAM   2 Tier 2 25%25%None
TESTOSTERONE CYPIONATE INJECTION   2 Tier 2 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TESTOSTERONE ENANTHATE INJECTION   2 Tier 2 25%25%P
TETANUS AND DIPHTHERIA TOXOIDS ADSORBED FOR ADULT USE 2 UNT/VIAL   3 Tier 3 25%25%None
TETANUS TOXOID ADSORBED VIAL 5LF   2 Tier 2 25%25%None
TETRACYCLINE 250 MG ORAL CAPSULE   1 Tier 1 25%25%None
TETRACYCLINE 500MG CAPSULE   1 Tier 1 25%25%None
TEV-TROPIN 5MG VIAL   5 Tier 5 25%25%P
THALOMID 100MG CAPSULE 140 BOX   5 Tier 5 25%25%P Q:90
/30Days
THALOMID 150MG CAPSULE   5 Tier 5 25%25%P Q:60
/30Days
THALOMID 200MG CAPSULE 28 BLPK   5 Tier 5 25%25%P Q:60
/30Days
THALOMID 50MG CAPSULE 280 BOX   5 Tier 5 25%25%P Q:60
/30Days
THEO-24 100MG CAPSULE SA   3 Tier 3 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
THEO-24 200MG CAPSULE SA   3 Tier 3 25%25%None
THEO-24 300MG CAPSULE SA   3 Tier 3 25%25%None
THEO-24 400MG CAPSULE SA   3 Tier 3 25%25%None
THEOCHRON 100MG TABLET SA   1 Tier 1 25%25%None
THEOCHRON 100MG TABLET SA   1 Tier 1 25%25%None
THEOCHRON 200MG TABLET SA 100 EA   1 Tier 1 25%25%None
THEOCHRON TABLETS EXTENDED RELEASE 300MG 100 BOT   1 Tier 1 25%25%None
THEOPHYLLINE 400MG TABLET SA   2 Tier 2 25%25%None
THEOPHYLLINE 600MG TABLET SA   2 Tier 2 25%25%None
THEOPHYLLINE ANHYDROUS ER TABLET 200MG (1000 CT)   1 Tier 1 25%25%None
THEOPHYLLINE TABLET ER 300MG (100 CT)   1 Tier 1 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
THEOPHYLLINE TABLET ER 450MG (100 CT)   2 Tier 2 25%25%None
THERMAZENE 50GM CREAM   1 Tier 1 25%25%None
THIOGUANINE TABLET LOID 40MG   3 Tier 3 25%25%None
THIORIDAZINE 100MG TABLET   1 Tier 1 25%25%None
THIORIDAZINE HCL 10MG TABLET (1000 CT)   1 Tier 1 25%25%None
THIORIDAZINE HCL 25MG TABLET (1000 CT)   1 Tier 1 25%25%None
THIORIDAZINE HCL 50MG TABLET (1000 CT)   1 Tier 1 25%25%None
THIOTEPA POWDER FOR INJECTION 15MG/VIL 1 VIAL SINGLE DOSE CRTN   2 Tier 2 25%25%P
THIOTHIXENE 10MG CAPSULE   1 Tier 1 25%25%None
THIOTHIXENE 1MG CAPSULE (100 CT)   1 Tier 1 25%25%None
THIOTHIXENE 2MG CAPSULE   1 Tier 1 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
THIOTHIXENE 5MG CAPSULE   1 Tier 1 25%25%None
THYMOGLOBULIN 25MG VIAL   3 Tier 3 25%25%P
TICLOPIDINE 250 MG ORAL TABLET   2 Tier 2 25%25%None
TIKOSYN .125MG CAPSULE   3 Tier 3 25%25%None
TIKOSYN .250MG CAPSULE   3 Tier 3 25%25%None
TIKOSYN .5MG CAPSULE   3 Tier 3 25%25%None
TIMOLOL 0.0025 MG/MG OPHTHALMIC GEL   2 Tier 2 25%25%None
TIMOLOL 0.005 MG/MG OPHTHALMIC GEL   2 Tier 2 25%25%None
TIMOLOL 2.5 MG/ML OPHTHALMIC SOLUTION [TIMOPTIC]   3 Tier 3 25%25%None
TIMOLOL 5 MG/ML OPHTHALMIC SOLUTION [TIMOPTIC]   3 Tier 3 25%25%None
TIMOLOL MAL SOL 0.25% OP 15ML BOT   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TIMOLOL MAL SOL 0.5% OP 10ML BOT   2 Tier 2 25%25%None
TIMOLOL MALEATE 10MG TABLET   1 Tier 1 25%25%None
TIMOLOL MALEATE 20MG TABLET   1 Tier 1 25%25%None
TIMOLOL MALEATE 5MG TABLET   1 Tier 1 25%25%None
TIZANIDINE HCL 2MG TABLET (150 CT)   2 Tier 2 25%25%None
TIZANIDINE HCL 4MG TABLET 150 BOT   2 Tier 2 25%25%None
TOBRADEX EYE OINTMENT   3 Tier 3 25%25%None
TOBRAMYCIN 10MG/ML VIAL   1 Tier 1 25%25%None
TOBRAMYCIN 40MG/ML VIAL   1 Tier 1 25%25%None
TOBRAMYCIN 60MG/0.9% NACL   3 Tier 3 25%25%None
TOBRAMYCIN 80MG/0.9% NACL   3 Tier 3 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOBRAMYCIN INHALATION SOLUTION   5 Tier 5 25%25%P
TOBRAMYCIN OPHTHALMIC SOLUTION 0.3% 5ML BOT   1 Tier 1 25%25%None
TOBRAMYCIN-DEXAMETH OPTH SUSP   2 Tier 2 25%25%None
TOBRASOL 0.3% EYE DROPS   1 Tier 1 25%25%None
TOBREX 0.3% EYE OINTMENT   3 Tier 3 25%25%None
TOLAZAMIDE TABLETS 250MG 100 BOT   2 Tier 2 25%25%None
TOLAZAMIDE TABLETS 500MG 100 BOT   2 Tier 2 25%25%None
TOLBUTAMIDE 500MG TABLET   2 Tier 2 25%25%None
TOLMETIN SODIUM 200MG TABLET   2 Tier 2 25%25%None
TOLMETIN SODIUM 400MG CAPSULE   2 Tier 2 25%25%None
TOLMETIN SODIUM 600MG TABLET   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOPIRAMATE 25 MG SPRINKLE CAP   2 Tier 2 25%25%None
TOPIRAMATE SPRINKLE CAPSULES 15MG 60 BOT   2 Tier 2 25%25%None
TOPIRAMATE TABLETS 100MG 1000 BOT   2 Tier 2 25%25%None
TOPIRAMATE TABLETS 200MG 1000 BOT   2 Tier 2 25%25%None
TOPIRAMATE TABLETS 25MG 1000 BOT   2 Tier 2 25%25%None
TOPIRAMATE TABLETS 50MG 1000 BOT   2 Tier 2 25%25%None
TOPOTECAN HYDROCHLORIDE FOR INJECTION   2 Tier 2 25%25%P
TORSEMIDE 100 MG ORAL TABLET   2 Tier 2 25%25%None
TORSEMIDE 20 MG ORAL TABLET   2 Tier 2 25%25%None
TORSEMIDE TABLETS 10 MG   2 Tier 2 25%25%None
TORSEMIDE TABLETS 5 MG   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRACLEER 125MG TABLET   5 Tier 5 25%25%P Q:180
/90Days
TRACLEER 62.5MG TABLET   5 Tier 5 25%25%P Q:360
/90Days
TRAMADOL HCL 50 MG TABLET   1 Tier 1 25%25%None
TRAMADOL HCL-ACETAMINOPHEN 37.5-325MG TABLET (1000 CT)   2 Tier 2 25%25%None
TRAMADOL HYDROCHLORIDE 100 MG ER TABLET 24 HR   2 Tier 2 25%25%None
TRAMADOL HYDROCHLORIDE 200 MG ER TABLET 24 HR   2 Tier 2 25%25%None
TRANDOLAPRIL 1MG TABLET   2 Tier 2 25%25%None
TRANDOLAPRIL 2MG TABLET   2 Tier 2 25%25%None
TRANDOLAPRIL 4MG TABLET   2 Tier 2 25%25%None
TRANSDERM-SCOP 1.5MG 24 PKG   3 Tier 3 25%25%None
TRANYLCYPROMINE SULFATE 10MG TABLET   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRAVASOL 10% SOLUTION VIAFLEX   2 Tier 2 25%25%P
TRAVATAN Z 0.04MG DROPS 2.5ML BOT   3 Tier 3 25%25%None
TRAZODONE 300MG TABLET   1 Tier 1 25%25%None
TRAZODONE HCL TABLET USP 100MG (500 CT)   1 Tier 1 25%25%None
TRAZODONE HCL TABLET USP 150MG (100 CT)   1 Tier 1 25%25%None
TRAZODONE HCL TABLET USP 50MG (500 CT)   1 Tier 1 25%25%None
TRECATOR 250MG TABLET   3 Tier 3 25%25%None
TRELSTAR DEPOT MIXJET FOR INJECTION 3.75 MG   3 Tier 3 25%25%P Q:1
/30Days
TRELSTAR MIXJET FOR INJECTION 11.25 MG   3 Tier 3 25%25%P Q:1
/90Days
TRETINOIN 0.01% GEL 45GM TUBE   2 Tier 2 25%25%None
TRETINOIN 0.025% GEL 45GM TUBE   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRETINOIN 0.05% CREAM 45GM TUBE   2 Tier 2 25%25%None
TRETINOIN 0.1% CREAM 45GM TUBE   2 Tier 2 25%25%None
TRETINOIN 10MG CAPSULE   2 Tier 2 25%25%None
TRETINOIN CREAM   2 Tier 2 25%25%None
TRI PREVIFEM TABLETS   2 Tier 2 25%25%None
TRI-LEGEST FE 5-7-9-7 TABLET   2 Tier 2 25%25%None
TRI-SPRINTEC 7DAYSX3 28 TABLET   1 Tier 1 25%25%None
TRIAMCINOLONE 0.1% OINTMENT   1 Tier 1 25%25%None
TRIAMCINOLONE 0.1% PASTE   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 80GM TUBE   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.1% LOTION 60ML BOTPL   1 Tier 1 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIAMCINOLONE ACETONIDE 0.025% CREAM 80GM TUBE   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.025% LOTION 2 FL OZ BOT   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.05% CREAM 15GM TUBE   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE   1 Tier 1 25%25%None
TRIAMCINOLONE ACETONIDE 0.1% CREAM 80GM TUBE   1 Tier 1 25%25%None
TRIAMTERENE/HCTZ 25/37.5MG CAPSULES (100 CT)   1 Tier 1 25%25%None
TRIAMTERENE/HCTZ 37.5/25 TABLET   1 Tier 1 25%25%None
TRIAMTERENE/HCTZ 75/50 TABLET   1 Tier 1 25%25%None
TRIDERM 0.1% CREAM   1 Tier 1 25%25%None
TRIDERM 0.1% OINTMENT   1 Tier 1 25%25%None
TRIFLUOPERAZINE 1MG TABLET   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIFLUOPERAZINE HCL 2MG TABLET   2 Tier 2 25%25%None
TRIFLUOPERAZINE HCL 5MG TABLET   2 Tier 2 25%25%None
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)   2 Tier 2 25%25%None
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML BOT   2 Tier 2 25%25%None
TRIHEXYPHENIDYL HCL 5MG TABLET (100 CT)   1 Tier 1 25%25%None
TRIHEXYPHENIDYL HCL ELIXIR 5%/2 16 FLO BOT   1 Tier 1 25%25%None
TRIHEXYPHENIDYL HCL TABLET 2MG (1000 CT)   1 Tier 1 25%25%None
TRIHIBIT PRESERVATIVE FREE   3 Tier 3 25%25%None
TRIMETHOPRIM TABLETS   1 Tier 1 25%25%None
TRINESSA TABLET   1 Tier 1 25%25%None
TRIPEDIA PRESERVATIVE FREE 6.7;23.4; UNT/.5 ML;   3 Tier 3 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRISENOX 10MG/10ML AMPULE   3 Tier 3 25%25%P
TRIVORA-28 TABLET   2 Tier 2 25%25%None
TRIZIVIR TABLET   5 Tier 5 25%25%None
TROPHAMINE INJECTION SOLUTION   3 Tier 3 25%25%P
TROPHAMINE INJECTION SOLUTION 6%   3 Tier 3 25%25%P
TROPICAMIDE 0.5% EYE DROPS   1 Tier 1 25%25%None
TROPICAMIDE OPHTHALMIC SOLUTION USP   1 Tier 1 25%25%None
TROSPIUM CHLORIDE TABLETS   2 Tier 2 25%25%Q:180
/90Days
TRUVADA TABLET   5 Tier 5 25%25%None
TWINRIX TF PF VACCINE 720UNT/20ML 10 X 1ML VIALSD   3 Tier 3 25%25%P
TYGACIL 50MG VIAL 10 VILSU BOX   3 Tier 3 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TYKERB 250MG TABLET   5 Tier 5 25%25%Q:540
/90Days
TYPHIM VI 25MCG/0.5ML VIAL   3 Tier 3 25%25%None
TYZEKA 600MG TABLET (30 CT)   5 Tier 5 25%25%P
TYZINE 0.1% NOSE DROPS   3 Tier 3 25%25%None
TYZINE PEDIATRIC 0.05% DROP   3 Tier 3 25%25%None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D BravoRx (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.