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2011 Medicare Part D and Medicare Advantage Plan Formulary Browser
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

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PDP     MAPD
Scroll down to see formulary results.

CIGNA Medicare Rx Plan Two (PDP) (S5617-202-0)
Tier 1 (170)
Tier 2 (1309)
Tier 3 (1123)
Tier 4 (446)
Tier 5 (405)
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
CIGNA Medicare Rx Plan Two (PDP) (S5617-202-0)
Benefit Details           
The CIGNA Medicare Rx Plan Two (PDP) (S5617-202-0)
Formulary Drugs Starting with the Letter M
in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter M

Drug Name		 Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MACRODANTIN 25MG CAPSULE   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MAGENSIUM SULFATE IN 5% DEXTROSE INJECTION 5-1 24 X 100ML CTR   2 Preferred Generic/Preferred Brand $3.00$7.50None
MAGNESIUM SULFATE 4% IV SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50P
MAGNESIUM SULFATE 8% IV SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50P
MAGNESIUM SULFATE INJECTION 5 GM/10ML   2 Preferred Generic/Preferred Brand $3.00$7.50P
MALARONE 250-100MG TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MALARONE 62.5-25MG PED TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MALATHION 5 MG/ML TOPICAL LOTION   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MAPROTILINE 25MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MAPROTILINE 50MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MAPROTILINE 75MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MARGESIC H 5MG-500MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MARINOL 10MG CAPSULE   5 Specialty Tier 33%33%P
MARINOL 5MG CAPSULE   5 Specialty Tier 33%33%P
MARPLAN 10MG TABLET (100 CT)   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MATULANE 50MG CAPSULE   5 Specialty Tier 33%33%None
MAXALT 10MG TABLET 12 CRTN   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:18
/30Days
MAXALT 5MG TABLET 12 CRTN   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:27
/30Days
MAXALT MLT 10MG TABLET 4X3 UNIT DOSE CASE   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:18
/30Days
MAXALT MLT 5MG TABLET 4X3 UNIT CASE   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:27
/30Days
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MAXIDEX OPHTHALMIC SUSPENSION 0.1% 5ML BOT   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MAXIDONE 10/750MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MAXIPIME 1G VIAL   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MAXIPIME 2G ADD-VANTAGE VL   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MEBENDAZOLE 100MG TABLET CHEW   2 Preferred Generic/Preferred Brand $3.00$7.50None
MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT   1 Preferred Generic $0.00$0.00None
MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT   1 Preferred Generic $0.00$0.00None
MECLOFENAMATE 100MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MECLOFENAMATE 50MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEDROXYPROGESTERONE 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEDROXYPROGESTERONE 2.5MG   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MEDROXYPROGESTERONE 5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEFLOQUINE HCL 250MG TABLET 25 BOT   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEGACE 40MG/ML ORAL SUSP   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MEGACE ES 625MG/5ML SUSP   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEGESTROL 20MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEGESTROL ACETATE 400MG/10ML SUSPENSION ORAL   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEGESTROL ACETATE 40MG TABLET (250 CT)   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MELOXICAM 15MG TABLET (500 CT)   1 Preferred Generic $0.00$0.00None
MELOXICAM 7.5MG/5ML SUSPENSION ORAL   1 Preferred Generic $0.00$0.00None
MELOXICAM TABLETS 7.5MG   1 Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MELPHALAN 5 MG/ML INJECTABLE SOLUTION   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MENACTRA INJECTION 4MCG/0.5ML 5 X .5ML SYR   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MENOMUNE-A/C/Y/W-135 VIAL   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MENVEO INJECTION KIT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEPERIDINE 10MG/ML SYRINGE   2 Preferred Generic/Preferred Brand $3.00$7.50P
MEPERIDINE 25MG/ML VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50P
MEPERIDINE 50MG/5ML SYRUP   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEPERIDINE 50MG/ML VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50P
MEPERIDINE HCL 50MG TABLET (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEPERIDINE HCL INJECTION 75MG 25 X 1ML VIALSD   2 Preferred Generic/Preferred Brand $3.00$7.50P
MEPERIDINE HCL TABLET 100MG (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MEPERIDINE HYDROCHLORIDE INJECTION 100MG/ML 25 X 1 ML VIALSD   2 Preferred Generic/Preferred Brand $3.00$7.50P
MEPROBAMATE 200MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEPROBAMATE 400MG TABLET (100 CT)   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEPRON 750MG/5ML ORAL SUSP   5 Specialty Tier 33%33%None
MERCAPTOPURINE 50MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MEROPENEM FOR INJECTION   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MERREM INJECTION 500MG 10X20MLVIALS VIAL   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MERUVAX II VACCINE/DILUENT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MESALAMINE 4G/60ML ENEMA   2 Preferred Generic/Preferred Brand $3.00$7.50None
MESNA INJECTION 1GM/ML 10ML VIALMD CRTN   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MESNEX 400MG TABLET   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MESNEX INJECTION   5 Specialty Tier 33%33%P
MESTINON 180MG TIMESPAN   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MESTINON 60MG/5ML SYRUP   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MESTINON TABLETS 60MG 100 BOT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METADATE ER 20MG TABLET SA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METAPROTERENOL 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METAPROTERENOL 10MG/5ML SYR   2 Preferred Generic/Preferred Brand $3.00$7.50None
METAPROTERENOL 20MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METFORMIN HCL 1000MG TABLET (500 CT)   1 Preferred Generic $0.00$0.00None
METFORMIN HCL 500MG TABLET (1000 CT)   1 Preferred Generic $0.00$0.00None
METFORMIN HCL 850MG TABLET   1 Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METFORMIN HCL ER 500MG TABLET SR 24HR   1 Preferred Generic $0.00$0.00None
METFORMIN HCL ER 750MG TABLET (100 CT)   1 Preferred Generic $0.00$0.00None
METHADONE 10MG/5ML SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADONE 5MG/5ML SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADONE HCL 5MG TABLET (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADONE HCL ORAL CONCENTRATE 10MG 946ML BOT   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADONE HYDROCHLORIDE INJECTION 10MG/ML   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADONE HYDROCHLORIDE TABLETS 10 MG   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADOSE 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHADOSE 5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHAMPHETAMINE HYDROCHLORIDE TABLETS 5 MG   2 Preferred Generic/Preferred Brand $3.00$7.50P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METHAZOLAMIDE 25MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHAZOLAMIDE 50MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHENAMINE HIPPURATE 1G TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHERGINE 0.2MG TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHIMAZOLE TABLETS   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHIMAZOLE TABLETS   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHITEST 10MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METHOCARBAMOL 500MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHOCARBAMOL 750MG TABLET (500 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHOTREXATE 2.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHOTREXATE FOR INJECTION 1 GM/ML   2 Preferred Generic/Preferred Brand $3.00$7.50P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METHOTREXATE INJECTION 25 MG/ML   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHSCOPOLAMINE BROMIDE 2.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHSCOPOLAMINE BROMIDE TABLETS 5MG 60 BOT   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYCLOTHIAZIDE 5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLDOPA 250MG TABLET   1 Preferred Generic $0.00$0.00None
METHYLDOPA 500MG TABLET   1 Preferred Generic $0.00$0.00None
METHYLDOPA/HCTZ 250-15 TABLET   1 Preferred Generic $0.00$0.00None
METHYLDOPA/HCTZ 250-25 TABLET   1 Preferred Generic $0.00$0.00None
METHYLDOPATE 250MG/5ML VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLIN 10 MG CHEWABLE   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHYLIN 10MG TABLET (100 CT)   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METHYLIN 2.5 MG CHEWABLE TAB   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHYLIN 20MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METHYLIN 5 MG CHEWABLE TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHYLIN ER 10MG TABLET SA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METHYLIN ER 20MG TABLET SA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METHYLIN SOLUTION 5MG/5ML 500 ML BOT   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHYLIN TABLET 5MG (100 CT)   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
METHYLPHENIDATE 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLPHENIDATE 2 MG/ML ORAL SOLUTION [METHYLIN]   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
METHYLPHENIDATE 20MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLPHENIDATE 3.33 MG/HR TRANSDERMAL PATCH [DAYTRANA] 9 HR   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METHYLPHENIDATE 5MG TABLET (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLPHENIDATE TABLETS 20MG 100 TABS BOT   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLPR ACE INJ 80MG/ML   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE 16MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE 1GM VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE 32MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE 4 MG ORAL TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METHYLPREDNISOLONE 40MG/ML VL 5ML   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE 8 MG ORAL TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE SODIUM SUCCINATE POWDER FOR INJECTION 125MG 25X125MG VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50P
METHYLPREDNISOLONE SODIUM SUCCINATE POWDER FOR INJECTION 40MG 25X40MG VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM   2 Preferred Generic/Preferred Brand $3.00$7.50P
METIPRANOLOL 0.3% EYE DROPS   1 Preferred Generic $0.00$0.00None
METOCLOPRAMIDE HYDROCHLORIDE TABLETS 10MG 500 BOTPL   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOCLOPRAMIDE INJECTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOCLOPRAMIDE SOLUTION ORAL USP 5MG 1 PT BOT   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOCLOPRAMIDE TABLETS   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOLAZONE 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOLAZONE 2.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOLAZONE 5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOPROLOL SUCCINATE 25MG TABLET SR 24HR   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
METOPROLOL SUCCINATE 50MG TABLET SR 24HR   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METOPROLOL SUCCINATE TABLETS EXTENDED RELEASE 100MG 100 BOT   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
METOPROLOL SUCINNATE TABLETS EXTENDED RELEASE 200MG 1000 BOT   2 Preferred Generic/Preferred Brand $3.00$7.50Q:60
/30Days
METOPROLOL TARTRATE 25MG TABLET (100 CT)   1 Preferred Generic $0.00$0.00None
METOPROLOL TARTRATE INJECTION USP 5MG 10X5ML VIALSD   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT)   1 Preferred Generic $0.00$0.00None
METOPROLOL TARTRATE TABLET USP 100MG (1000 CT)   1 Preferred Generic $0.00$0.00None
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE 0.75% CREAM   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE 0.75% LOTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
METRONIDAZOLE 375MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE INJECTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE TABLETS USP 250MG 250 BOTPL   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE TABLETS USP 500MG 100 BOTPL   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE VAGINAL GEL   2 Preferred Generic/Preferred Brand $3.00$7.50None
METRONIDAZOLE VAGINAL GEL 0.75%   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MEXILETINE 150MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEXILETINE 200MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MEXILETINE 250MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MICARDIS 20MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MICARDIS 40MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
MICARDIS 80MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
MICARDIS HCT 40/12.5MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
MICARDIS HCT 80/12.5MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
MICARDIS HCT 80/25MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:30
/30Days
MICONAZOLE 3 200MG SUPPOS.   2 Preferred Generic/Preferred Brand $3.00$7.50None
MICROGESTIN 1-0.02MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MICROGESTIN 1.5-0.03MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MICROGESTIN FE 1.5/30 TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MICROGESTIN FE 1/20 TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MIDODRINE HCL 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MIDODRINE HCL 2.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MIDODRINE HCL 5MG TABLET (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
MIGERGOT 2-100MG SUPPOSITORY RECTAL   2 Preferred Generic/Preferred Brand $3.00$7.50None
MIGRANAL 0.5MG/SPRY AEROSOL SPRAY W/PUMP   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00Q:8
/30Days
MINITRAN 0.1MG/HR PATCH 30 EA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MINITRAN 0.2MG/HR PATCH 30 EA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MINITRAN 0.4MG/HR PATCH 30 EA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MINITRAN 0.6MG/HR PATCH 30 EA   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MINOCIN PELLET FILLED CAPSULES 100MG (50 CT)   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MINOCIN PELLET FILLED CAPSULES 50MG (100 CT)   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MINOCYCLINE 100MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MINOCYCLINE 50MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOCYCLINE HCL 100MG TABLET 60 EA   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOCYCLINE HCL 75MG CAPSULE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOCYCLINE HCL 75MG TABLET (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOCYCLINE HYDROCHLORIDE TABLETS 50MG   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOXIDIL 10MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MINOXIDIL 2.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MIRAPEX 0.75MG TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MIRAPEX ER 0.375 MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MIRAPEX ER 0.75 MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MIRAPEX ER 1.5 MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MIRAPEX ER 3 MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MIRAPEX ER 4.5 MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MIRTAZAPINE 15MG TABLET (1000 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE 15MG TABLET RAPID DISSOLVE   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE 30MG TABLET RAPID DISSOLVE   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE TABLET 30MG (30 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE TABLET 7.5MG (30 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MIRTAZAPINE TABLETS 45MG 30 BOT   2 Preferred Generic/Preferred Brand $3.00$7.50Q:30
/30Days
MISOPROSTOL 100MCG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MISOPROSTOL 200MCG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MITOMYCIN POWDER FOR INJECTION USP 20MG VIAL   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MITOXANTRONE INJECTION 2MG 125ML VIAL   5 Specialty Tier 33%33%P
MOEXIPRIL HCL 15MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOEXIPRIL HCL 7.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOMETASONE FUROATE CREAM 0.1% 45GM TUBE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOMETASONE FUROATE OINTMENT 0.1% 45GM TUBE   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOMETASONE FUROATE TOPICAL SOLUTION 0.1%   2 Preferred Generic/Preferred Brand $3.00$7.50None
MONOKET 10MG TABLET   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MORPHINE SULFATE 100MG TABLET SA   2 Preferred Generic/Preferred Brand $3.00$7.50Q:120
/30Days
MORPHINE SULFATE 15MG TABLET SA   2 Preferred Generic/Preferred Brand $3.00$7.50Q:180
/30Days
MORPHINE SULFATE 20 MG/ML SOL   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE 200MG TABLET SA   2 Preferred Generic/Preferred Brand $3.00$7.50Q:120
/30Days
MORPHINE SULFATE 30MG TABLET SA   2 Preferred Generic/Preferred Brand $3.00$7.50Q:180
/30Days
MORPHINE SULFATE 5MG 25 X 1ML VIAL   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE INJECTION 0.5MG 5X10ML VIALGL   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE INJECTION 1MG 5X10ML VIALGL   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE ORAL SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE ORAL SOLUTION   2 Preferred Generic/Preferred Brand $3.00$7.50None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MORPHINE SULFATE TABLET ER 60MG (100 CT)   2 Preferred Generic/Preferred Brand $3.00$7.50Q:120
/30Days
MORPHINE SULFATE TABLETS   2 Preferred Generic/Preferred Brand $3.00$7.50None
MORPHINE SULFATE TABLETS   2 Preferred Generic/Preferred Brand $3.00$7.50None
MOZOBIL SOLUTION 24MG/1.2ML   5 Specialty Tier 33%33%P
MULTAQ DRONEDARONE TABLETS 400MG 60 BOT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00Q:60
/30Days
MUPIROCIN 2% OINTMENT   2 Preferred Generic/Preferred Brand $3.00$7.50None
MUSTARGEN 10MG VIAL   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MYCAMINE 50MG VIAL   5 Specialty Tier 33%33%P
MYCAMINE FOR INJECTION SOLUTION   5 Specialty Tier 33%33%P
MYCOBUTIN 150MG CAPSULE   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None
MYCOPHENOLATE MOFETIL CAPSULES 250MG 100 BOT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
MYCOPHENOLATE MOFETIL TABLETS 500MG 500 BOT   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MYDRAL 0.5% DROPS   2 Preferred Generic/Preferred Brand $3.00$7.50None
MYDRAL 1% DROPS   2 Preferred Generic/Preferred Brand $3.00$7.50None
MYFORTIC 180MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MYFORTIC 360MG TABLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00P
MYOZYME 50MG VIAL   5 Specialty Tier 33%33%P
MYSOLINE ANTICONVULSANT TABLETS 250MG 100 BOT   4 Non-Preferred Generic/Non-Preferred Brand $78.00$195.00None
MYTELASE 10MG CAPLET   3 Non-Preferred Generic/Preferred Brand $36.00$90.00None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D CIGNA Medicare Rx Plan Two (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.





 
 


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  • 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 PDPCompare.com and MACompare.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.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.
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