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Health Net Orange Option 1 (PDP) (S5678-056-0)
Tier 1 (1401)
Tier 2 (633)
Tier 3 (558)
Tier 4 (668)
Tier 5 (286)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
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Cick on the first letter of your drug name to browse the formulary:

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2011 Medicare Part D Plan Formulary Information
Health Net Orange Option 1 (PDP) (S5678-056-0)
Sanctioned Plan           
The Health Net Orange Option 1 (PDP) (S5678-056-0)
Formulary Drugs Starting with the Letter Z

in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
Drugs Starting with Letter Z

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
ZALEPLON 10MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZALEPLON 5MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZANOSAR 1GM VIAL   4 Tier 4 Injectable 25%25%None
ZANTAC 25 EFFERDOSE TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
ZANTAC 25MG/ML VIAL   4 Tier 4 Injectable 25%25%None
ZANTAC 50MG/50ML PLAST-BAG   4 Tier 4 Injectable 25%25%None
ZARONTIN 250MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZARONTIN 250MG/5ML SYRUP   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZAVESCA 100MG CAPSULE   5 Tier 5 Specialty 25%25%P
ZAZOLE 0.4% CREAM WITH APPLICATOR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZAZOLE 0.8% CREAM WITH APPLICATOR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZAZOLE 80MG SUPPOSITORY VAGINAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZEMAIRA 1000MG VIAL   5 Tier 5 Specialty 25%25%P
ZEMPLAR 1 MCG CAPSULE   2 Tier 2 Preferred Brand $37.00$74.00None
ZEMPLAR 2 MCG CAPSULE   2 Tier 2 Preferred Brand $37.00$74.00None
ZEMPLAR 2 MCG/ML VIAL   4 Tier 4 Injectable 25%25%None
ZEMPLAR 4 MCG CAPSULE   2 Tier 2 Preferred Brand $37.00$74.00None
ZEMPLAR 5MCG/ML VIAL   4 Tier 4 Injectable 25%25%None
ZERLOR TABLET 712.8MG/60MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZETIA 10MG TABLET (90 CT)   2 Tier 2 Preferred Brand $37.00$74.00None
ZIAGEN 20MG/ML SOLUTION   2 Tier 2 Preferred Brand $37.00$74.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZIAGEN 300MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
ZIDOVUDINE 100MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
ZIDOVUDINE 10MG/ML SYRUP   1 Tier 1 Preferred Generic $4.00$8.00None
ZIDOVUDINE 300MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
ZINACEF 7.5GM VIAL   4 Tier 4 Injectable 25%25%None
ZINACEF ADD VTG FOR INJECTION 750MG 10 VIAL   4 Tier 4 Injectable 25%25%None
ZINACEF INJECTION ADD VANTAGE 1.5GM 10 VIAL   4 Tier 4 Injectable 25%25%None
ZINACEF/DEXTROSE 750MG/50ML   4 Tier 4 Injectable 25%25%None
ZINACEF/WATER 1.5GM/50ML   4 Tier 4 Injectable 25%25%None
ZITHROMAX IV 500MG VIAL 10 VIAL BOX   4 Tier 4 Injectable 25%25%None
ZOFRAN 2MG/ML MDV VIAL   4 Tier 4 Injectable 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZOLINZA 100MG CAPSULE   5 Tier 5 Specialty 25%25%P
ZOLPIDEM TARTRATE 10 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZOLPIDEM TARTRATE TABLETS 5 MG   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZOMETA 4MG/5ML VIAL   5 Tier 5 Specialty 25%25%None
ZONEGRAN 100MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZONEGRAN 25MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
ZONISAMIDE 100MG CAPSULE (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
ZONISAMIDE 25MG CAPSULE (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
ZONISAMIDE 50MG CAPSULE (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
ZORBTIVE 8.8MG VIAL   5 Tier 5 Specialty 25%25%P
ZOSTAVAX VIAL   4 Tier 4 Injectable 25%25%Q:1
/999Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZOSYN 2/0.25GM PRE-MIX BAG   4 Tier 4 Injectable 25%25%None
ZOSYN 3/0.375GRAM 24 BAGS PKG   4 Tier 4 Injectable 25%25%None
ZOSYN 3/0.375GRAM VIAL 1 VIAL SU   4 Tier 4 Injectable 25%25%None
ZOVIA 1/35-28 TABLET   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZOVIA 1/50-28 TABLET   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
ZOVIRAX 5% CREAM   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZOVIRAX 5% OINTMENT   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZYFLO CR 600 MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00P Q:4
/1Days
ZYLET 0.3%-0.5% SUSPENSION DROPS(FINAL DOSAGE FORM)(ML)   2 Tier 2 Preferred Brand $37.00$74.00Q:15
/10Days
ZYMAR 0.3% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00S Q:5
/7Days
ZYMAXID 0.5 % O/S 2.5 ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00S
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZYPREXA 10MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZYPREXA 10MG VIAL   4 Tier 4 Injectable 25%25%None
ZYPREXA 15MG TABLET (1000 BOT)   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
ZYPREXA 2.5MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZYPREXA 20MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
ZYPREXA 5MG TABLET (30 BOT)   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZYPREXA 7.5MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
ZYPREXA ZYDIS 10MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
ZYPREXA ZYDIS 15MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
ZYPREXA ZYDIS 20MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
ZYPREXA ZYDIS 5MG TABLET (30 BLPK)   2 Tier 2 Preferred Brand $37.00$74.00Q:2
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZYVOX 100MG/5ML SUSPENSION   5 Tier 5 Specialty 25%25%P
ZYVOX 600MG TABLET   5 Tier 5 Specialty 25%25%P
ZYVOX 600MG/300ML IV SOLUTION   5 Tier 5 Specialty 25%25%None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D Health Net Orange Option 1 (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.