2011 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Plus (PDP) (S5810-222-0)
Sanctioned Plan
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The Aetna Medicare Rx Plus (PDP) (S5810-222-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 18 which includes: MO
|
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 |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in MO cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S Q:4 /30Days |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in MO cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in MO cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in MO cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MO cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MO cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MO cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in MO cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:55 /365Days |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MO cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELEGILINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SELEGILINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT ![Compare how all Medicare Part D PDP plans in MO cover SELENIUM SULFIDE LOTION USP 2.5% 4 FLOZ-118ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK ![Compare how all Medicare Part D PDP plans in MO cover SELFEMRA CAPSULES 10MG 28 CAPSULE BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:1 /1Days |
SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK ![Compare how all Medicare Part D PDP plans in MO cover SELFEMRA CAPSULES 20MG 28 CAPSULE 4X7 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:4 /1Days |
SELZENTRY 150MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SELZENTRY 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SELZENTRY 300MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SELZENTRY 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SEMPREX-D 60/8 CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SEMPREX-D 60/8 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | Q:2 /1Days |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | Q:4 /1Days |
SEROMYCIN CAPSULES 250MG ![Compare how all Medicare Part D PDP plans in MO cover SEROMYCIN CAPSULES 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | 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 MO cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:3 /1Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:4 /1Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:6 /1Days |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:2 /1Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:2 /1Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:3 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:6 /1Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in MO cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MO cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:2 /1Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MO cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:2 /1Days |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in MO cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:10 /1Days |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in MO cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in MO cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in MO cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in MO cover SIMCOR 1000-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in MO cover SIMCOR 500MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR ![Compare how all Medicare Part D PDP plans in MO cover SIMCOR 750MG-20MG TABLET MULTIPHASIC RELEASE 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMCOR TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover SIMCOR TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:2 /1Days |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in MO 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) |
5 |
Tier 5 |
25% | 25% | P Q:50 /28Days |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
SIMVASTATIN 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in MO cover SIMVASTATIN 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in MO cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SIMVASTATIN 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover SIMVASTATIN 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:1 /1Days |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in MO cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
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 MO cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in MO cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM BICARB INJ 8.4% ![Compare how all Medicare Part D PDP plans in MO cover SODIUM BICARB INJ 8.4%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CHLORIDE INJECTION 3% 24X500ML BAG ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CHLORIDE INJECTION 3% 24X500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CHLORIDE INJECTION USP .9 4X100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CHLORIDE IRRIGATION 0.9% 1000ML CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM FLUORIDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SODIUM FLUORIDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SODIUM LACTATE 1/6MOLAR INJ ![Compare how all Medicare Part D PDP plans in MO cover SODIUM LACTATE 1/6MOLAR INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SODIUM POLYSTYRENE SULFONATE POWDER ![Compare how all Medicare Part D PDP plans in MO cover SODIUM POLYSTYRENE SULFONATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in MO cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in MO cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in MO cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P S |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SORIATANE 22.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SORIATANE 22.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MO cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MO cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MO cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MO cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in MO cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SOTALOL HYDROCHLORIDE INJECTION 15MG/ML ![Compare how all Medicare Part D PDP plans in MO cover SOTALOL HYDROCHLORIDE INJECTION 15MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | P |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | P |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | P |
SPECTRACEF 400 MG DOSE PACK TB ![Compare how all Medicare Part D PDP plans in MO cover SPECTRACEF 400 MG DOSE PACK TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SPECTRACEF TABLETS 200 MG ![Compare how all Medicare Part D PDP plans in MO cover SPECTRACEF TABLETS 200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in MO cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:1 /1Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in MO cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:2 /1Days |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:2 /1Days |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:2 /1Days |
SPRYCEL TABLETS ![Compare how all Medicare Part D PDP plans in MO cover SPRYCEL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:1 /1Days |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in MO cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in MO cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | Q:8 /1Days |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in MO cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in MO cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in MO cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in MO cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in MO cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT ![Compare how all Medicare Part D PDP plans in MO cover STAVUDINE FOR ORAL SOLUTION 1MG/ML 200 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MO cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:1 /1Days |
STELARA 45 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover STELARA 45 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:1 /1Days |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in MO cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in MO cover STERILE VANCOMYCIN HCL INJECTION 10 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | P |
STERILE VANCOMYCIN HYDROCHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover STERILE VANCOMYCIN HYDROCHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | P |
STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in MO cover STERILE WATER FOR IRRIGATION 100 24 X 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in MO cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | P Q:3 /1Days |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | P Q:3 /1Days |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in MO cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL ![Compare how all Medicare Part D PDP plans in MO cover SULFACETAMIDE SODIUM 10% SUSPENSION TOPICAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in MO cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in MO cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT ![Compare how all Medicare Part D PDP plans in MO cover SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40MG ORAL SUSPENSION 473ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFATRIM PEDIATRIC SUSP ![Compare how all Medicare Part D PDP plans in MO cover SULFATRIM PEDIATRIC SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$2.00 | $6.00 | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in MO cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:5 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD ![Compare how all Medicare Part D PDP plans in MO cover SUMATRIPTAN SUCCINATE INJECTION 4MG/0.5ML 0.5 ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:5 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in MO cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:18 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in MO cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:18 /30Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in MO cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | Q:18 /30Days |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in MO cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in MO cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT ![Compare how all Medicare Part D PDP plans in MO cover SUPRAX CFIXIME TABLETS USP 400MG 50 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$20.00 | $45.00 | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SURMONTIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SURMONTIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:3 /1Days |
SUTENT 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SUTENT 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:3 /1Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:1 /1Days |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in MO cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:11 /25Days |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in MO cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$25.00 | $60.00 | Q:11 /25Days |
SYMLIN 0.6MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover SYMLIN 0.6MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | Q:20 /30Days |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MO cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$60.00 | $165.00 | None |