2011 Medicare Part D Plan Formulary Information |
Medco Medicare Prescription Plan - Choice (PDP) (S5660-172-0)
Benefit Details
 |
The Medco Medicare Prescription Plan - Choice (PDP) (S5660-172-0) Formulary Drugs Starting with the Letter A in CMS PDP Region 01 which includes: ME NH
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Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
A-HYDROCORT 100MG VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
A-METHAPRED 40MG UNIVIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ABILIFY 10MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:270 /90Days |
ABILIFY 15MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:180 /90Days |
ABILIFY 1MG/ML SOLUTION  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ABILIFY 20MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:90 /90Days |
ABILIFY 2MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:90 /90Days |
ABILIFY 30MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:90 /90Days |
ABILIFY 5MG TABLET (OTSUKA)  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABILIFY DISCMELT 10MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:270 /90Days |
ABILIFY DISCMELT 15MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:180 /90Days |
ABILIFY INJ 9.75MG  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ABRAXANE 100MG VIAL  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ACARBOSE 100MG TABLET S  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:270 /90Days |
ACARBOSE 50MG TABLET S  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:270 /90Days |
ACARBOSE TABLETS  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:270 /90Days |
ACCOLATE 10MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:180 /90Days |
ACCOLATE 20MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | Q:180 /90Days |
ACEBUTOLOL 200MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACEBUTOLOL 400MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETASOL HC SOLUTION 10ML 10 ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAZOLAMIDE 125MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAZOLAMIDE 250MG TABLET (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETAZOLAMIDE SOD 500MG VL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACETIC ACID 2% SOLUTION NON-ORAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETYLCYSTEINE 10% VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ACTHIB VACCINE VIAL 10-24UNT/5ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ACTICIN 5% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACTIMMUNE SOLUTION FOR INJECTION 100MCG  |
4 |
Specialty Drugs |
26% | 26% | P |
ACTONEL 150MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | S |
ACTONEL 30MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | P |
ACTONEL 35MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | S |
ACTONEL 5MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | S |
ACTOPLUS MET 15MG/500MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:270 /90Days |
ACTOPLUS MET 15MG/850MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:270 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTOS 15MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ACTOS 30MG TABLET (500 CT)  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ACTOS 45MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ACYCLOVIR 200MG CAPSULE (1000 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACYCLOVIR 200MG/5ML SUSP  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACYCLOVIR 400MG TABLET (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACYCLOVIR 800 MG ORAL TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ACYCLOVIR SODIUM 500MG VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ADACEL VIAL 2UNT/5UNT  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ADAGEN 250U/ML VIAL  |
4 |
Specialty Drugs |
26% | 26% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA] ![Compare how all Medicare Part D PDP plans in ME cover ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Drugs |
26% | 26% | P Q:2 /90Days |
ADAPALENE CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ADAPALENE GEL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ADVAIR DISKU MIS 100/50  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
ADVAIR DISKU MIS 250/50  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
ADVAIR DISKU MIS 500/50  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:36 /90Days |
ADVAIR HFA INHALER 230;21MCG;MCG  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:36 /90Days |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:36 /90Days |
AFEDITAB CR 30MG TABLET SA  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AFEDITAB CR 60MG TABLET SA  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFINITOR TABLETS  |
4 |
Specialty Drugs |
26% | 26% | P Q:180 /90Days |
AFINITOR TABLETS  |
4 |
Specialty Drugs |
26% | 26% | P Q:270 /90Days |
AFINITOR TABLETS 5 MG  |
4 |
Specialty Drugs |
26% | 26% | P Q:270 /90Days |
AGGRENOX 25-200MG CAPSULE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AK-CON 0.1% EYE DROPS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AKTOB 0.3% EYE DROPS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALA-CORT 1% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALBENZA 200MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ALBUTEROL SULFATE 4MG TABLET SR 12HR  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBUTEROL SULFATE 8MG TABLET SR 12HR  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ALBUTEROL SULFATE SOLUTION FOR INHALATION  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALBUTEROL SULFATE TABLET 2MG (500 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALBUTEROL TABLET 4MG (500 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALCOHOL 5%/DEXTROSE 5%  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALDURAZYME 2.9MG/5ML VIAL  |
4 |
Specialty Drugs |
26% | 26% | P |
ALENDRONATE SODIUM 10MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALENDRONATE SODIUM 40MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
ALENDRONATE SODIUM 5MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALENDRONATE SODIUM TABLET 35MG 20 CRTN  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALENDRONATE SODIUM TABLETS 70 MG  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALIMTA 500MG VIAL  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ALINIA 100MG/5ML SUSPENSION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALINIA 500MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALISKIREN 150 MG / VALSARTAN 160 MG ORAL TABLET [VALTURNA] ![Compare how all Medicare Part D PDP plans in ME cover ALISKIREN 150 MG / VALSARTAN 160 MG ORAL TABLET [VALTURNA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ALISKIREN 300 MG / VALSARTAN 320 MG ORAL TABLET [VALTURNA] ![Compare how all Medicare Part D PDP plans in ME cover ALISKIREN 300 MG / VALSARTAN 320 MG ORAL TABLET [VALTURNA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ALLOPURINOL TABLET 300MG (1000 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALLOPURINOL TABLETS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ALOCRIL 2% EYE DROPS  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ALORA 0.025MG PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALORA 0.05MG PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALORA 0.075MG PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALORA 0.1MG PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALPHAGAN P 0.1% DROPS  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALPHAGAN P 0.15% EYE DROPS  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ALREX 0.2% EYE DROPS  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMANTADINE 100MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMANTADINE 100MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMANTADINE HCL 50 MG/ 5 ML SYRUP  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMBIEN 10MG TABLET  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
AMBIEN TABLETS 5MG 100 BOT  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
AMCINONIDE 0.1% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMCINONIDE 0.1% LOTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMCINONIDE 0.1% OINTMENT 60GM TUBE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMIFOSTINE FOR INJECTION 500MG/VIAL  |
4 |
Specialty Drugs |
26% | 26% | None |
AMIKACIN 250MG/ML VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMIKACIN 50MG/ML VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOPHYLLINE 100MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMINOPHYLLINE 200MG TABLET (1000 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMINOSYN 10% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN 3.5% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN 5% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN 7% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN 8.5% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN HBC INJECTION SULFITE FREE 7%  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 10% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 15% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN II 3.5% IN D25W IV  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 3.5% IN D5W IV  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 3.5% M/D5W IV  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 4.25% IN D10W  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 4.25% IN D20W  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 4.25%-D25W IV  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 7% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 8.5% ELECTROLYT  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN II 8.5% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN PF INJECTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMINOSYN-HF 8% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN-PF 7% IV SOLUTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMIODARONE HCL 400MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMIODARONE HCL INJECTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMIODARONE HYDROCHLORIDE TABLETS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITIZA 8MCG CAPSULE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMITIZA CAPSULES 24MCG 60 CAP BOT  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMITRIP/CDP 25-10 TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITRIPTYLINE HCL 100MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITRIPTYLINE HCL 10MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITRIPTYLINE HCL 150 MG TAB  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/12  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/25] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/25].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 320 MG ORAL TABLET [EXFORGE HCT 10/320/25] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 320 MG ORAL TABLET [EXFORGE HCT 10/320/25].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 10 MG / TELMISARTAN 40 MG ORAL TABLET [TWYNSTA 40/10] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 10 MG / TELMISARTAN 40 MG ORAL TABLET [TWYNSTA 40/10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 10 MG / TELMISARTAN 80 MG ORAL TABLET [TWYNSTA 80/10] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 10 MG / TELMISARTAN 80 MG ORAL TABLET [TWYNSTA 80/10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/12.5  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/25] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/25].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 5 MG / TELMISARTAN 40 MG ORAL TABLET [TWYNSTA 40/5] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 5 MG / TELMISARTAN 40 MG ORAL TABLET [TWYNSTA 40/5].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AMLODIPINE 5 MG / TELMISARTAN 80 MG ORAL TABLET [TWYNSTA 80/5] ![Compare how all Medicare Part D PDP plans in ME cover AMLODIPINE 5 MG / TELMISARTAN 80 MG ORAL TABLET [TWYNSTA 80/5].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE 10MG TABLET (90 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMLODIPINE BESYLATE 5MG TABLET (90 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | Q:90 /90Days |
AMMONIUM LACTATE 12% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMMONIUM LACTATE 12% LOTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMNESTEEM 10MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMNESTEEM 20MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMNESTEEM 40MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-K CLV 500-125 MG TAB  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXAPINE 100MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXAPINE 150MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXAPINE 25MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXAPINE 50MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 125MG TABLET CHEW  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 200MG TABLET CHEW  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 250MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 400MG TABLET CHEW  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 500MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 500MG TABLET (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN 875MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 12.5MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPHETAMINE SALT COMBO 15MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPHETAMINE SALT COMBO 30MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPHETAMINE SALT COMBO 7.5MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPHETAMINE SALTS 20MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPHETAMINE SALTS 5 MG TAB  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPHOTERICIN B FOR INJECTION 50 MG  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN CAPSULES 250MG 100 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN FOR INJECTION POWDER  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN POWDER FOR INJECTION 1 GM/ML  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AMYLASES 109000 UNT / ENDOPEPTIDASES 68000 UNT / LIPASE 20000 UNT ENTERIC COATED CAPSULE [ZENPEP 20] ![Compare how all Medicare Part D PDP plans in ME cover AMYLASES 109000 UNT / ENDOPEPTIDASES 68000 UNT / LIPASE 20000 UNT ENTERIC COATED CAPSULE [ZENPEP 20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMYLASES 27000 UNT / ENDOPEPTIDASES 17000 UNT / LIPASE 5000 UNT ENTERIC COATED CAPSULE [ZENPEP 5] ![Compare how all Medicare Part D PDP plans in ME cover AMYLASES 27000 UNT / ENDOPEPTIDASES 17000 UNT / LIPASE 5000 UNT ENTERIC COATED CAPSULE [ZENPEP 5].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMYLASES 55000 UNT / ENDOPEPTIDASES 34000 UNT / LIPASE 10000 UNT ENTERIC COATED CAPSULE [ZENPEP 10] ![Compare how all Medicare Part D PDP plans in ME cover AMYLASES 55000 UNT / ENDOPEPTIDASES 34000 UNT / LIPASE 10000 UNT ENTERIC COATED CAPSULE [ZENPEP 10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AMYLASES 82000 UNT / ENDOPEPTIDASES 51000 UNT / LIPASE 15000 UNT ENTERIC COATED CAPSULE [ZENPEP 15] ![Compare how all Medicare Part D PDP plans in ME cover AMYLASES 82000 UNT / ENDOPEPTIDASES 51000 UNT / LIPASE 15000 UNT ENTERIC COATED CAPSULE [ZENPEP 15].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ANADROL-50 50MG TABLET (100 CT)  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | P |
ANAGRELIDE HCL 0.5MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ANAGRELIDE HCL 1MG CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ANASTROZOLE TABLETS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ANCOBON 250MG CAPSULE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ANCOBON 500MG CAPSULE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANDRODERM 2.5MG/24HR PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | P |
ANDRODERM 5MG/24HR PATCH  |
2 |
Preferred Brands |
$40.00 | $100.00 | P |
ANDROGEL 1%(50MG) GEL PACKET  |
2 |
Preferred Brands |
$40.00 | $100.00 | P |
ANESTACON 15ML  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ANIDULAFUNGIN 3.33 MG/ML INJECTABLE SOLUTION [ERAXIS] ![Compare how all Medicare Part D PDP plans in ME cover ANIDULAFUNGIN 3.33 MG/ML INJECTABLE SOLUTION [ERAXIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ANTABUSE 250MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
APOKYN 30 MG/3 ML CARTRIDGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
APRACLONIDINE 5 MG/ML OPHTHALMIC SOLUTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
APRI 0.15-0.03 TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
APTIVUS 250MG CAPSULE  |
4 |
Specialty Drugs |
26% | 26% | None |
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT  |
4 |
Specialty Drugs |
26% | 26% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANELLE 7-9-5 TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ARANESP 100MCG/ML VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:12 /90Days |
ARANESP 200MCG/0.4ML SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:5 /90Days |
ARANESP 200MCG/ML VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:12 /90Days |
ARANESP 25MCG/ML VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:24 /90Days |
ARANESP 300MCG/ML VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:12 /90Days |
ARANESP 500MCG/1ML SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:3 /90Days |
ARANESP 60MCG/ML VIAL  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:24 /90Days |
ARANESP PREFILLED SYRINGE SINGLE USE 100MCG/0.5ML 1 SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:6 /90Days |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:4 /90Days |
ARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:10 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:7 /90Days |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:10 /90Days |
ARANESP PREFILLED SYRINGE SINGLE USE 60MCG/0.3ML 60MCG/ 0.3ML SYR  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:7 /90Days |
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD  |
2 |
Preferred Brands |
$40.00 | $100.00 | P Q:24 /90Days |
ARCALYST INJECTION 220MG/VIAL  |
4 |
Specialty Drugs |
26% | 26% | None |
ARICEPT 10MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ARICEPT 5MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ARICEPT ODT 10MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ARICEPT ODT 5MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ARICEPT TABLETS  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
ARIMIDEX 1MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARIXTRA 10MG SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ARIXTRA 2.5MG SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ARIXTRA 5MG SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ARIXTRA 7.5MG SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AROMASIN 25MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ARRANON 250MG VIAL  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ARTHROTEC 50 50MG TABLET -200MCG (60 CT)  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ARTHROTEC 75 TABLET EC  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
ARZERRA INJECTION 100MG/5ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ASACOL 400MG TABLET EC  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ASACOL HD DELAYED RELEASE TABLETS 800MG 180 BOT  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ASCOMP W/CODEINE 30-50-325 CAPSULE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS] ![Compare how all Medicare Part D PDP plans in ME cover ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS] ![Compare how all Medicare Part D PDP plans in ME cover ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
ASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:3 /90Days |
ASMANEX TWISTHALER 110 MCG #30  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:3 /90Days |
ASMANEX TWISTHALER 220MCG #120  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:3 /90Days |
ASMANEX TWISTHALER 220MCG #30  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:3 /90Days |
ASMANEX TWISTHALER 220MCG #60  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:3 /90Days |
ASTELIN 137MCG AEROSOL SPRAY W/PUMP  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ASTEPRO 0.15% NASAL SPRAY 30 ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ATENOLOL 25MG TABLET (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATENOLOL TABLET USP 50MG (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATENOLOL TABLETS USP 100MG 1 BLPK  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATRIPLA TABLET 600MG/200MG  |
4 |
Specialty Drugs |
26% | 26% | None |
ATROPINE 0.025 MG / DIPHENOXYLATE 2.5 MG ORAL TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATROPINE 0.05MG/ML SYRINGE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
ATROPINE 0.1MG/ML SYRINGE  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
ATROVENT HFA AER 17MCG  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:77 /90Days |
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AVANDAMET 2MG/1000MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVANDAMET 2MG/500MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDAMET 4MG/500MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDAMET TABLET 4-1000MG  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDARYL 4MG/1MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDARYL 4MG/2MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDARYL 4MG/4MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AVANDARYL 8MG-2MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AVANDARYL 8MG-4MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AVANDIA 2MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDIA 4MG TABLET (90 CT)  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:180 /90Days |
AVANDIA 8MG TABLET (90 CT)  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVASTIN 100MG/4ML VIAL  |
3 |
Non-preferred Brands |
$95.00 | $237.50 | None |
AVELOX 400MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AVELOX ABC PACK 400MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AVELOX IV 400MG/250ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AVIANE 0.1-0.02 TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AVITA 0.025% CREAM  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AVODART 0.5MG SOFTGEL  |
2 |
Preferred Brands |
$40.00 | $100.00 | Q:90 /90Days |
AVONEX ADMIN PACK 30MCG SYR  |
4 |
Specialty Drugs |
26% | 26% | P Q:12 /90Days |
AVONEX ADMIN PACK 30MCG VL  |
4 |
Specialty Drugs |
26% | 26% | P Q:12 /90Days |
AZACTAM INJECTION  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZACTAM INJECTION 1GM/50ML  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZACTAM INJECTION 2GM/VIL  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZASITE 1% DROPS  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZATHIOPRINE 50MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AZATHIOPRINE SOD 100MG VIAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | P |
AZELASTINE 137 MCG NASAL SPRAY  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZELEX 20% CREAM 30GM TUBE  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZILECT 0.5MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZILECT 1MG TABLET  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZITHROMYCIN 250 MG TABLET  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZITHROMYCIN 33.3 MG/ML ER SUSPENSION [ZMAX] ![Compare how all Medicare Part D PDP plans in ME cover AZITHROMYCIN 33.3 MG/ML ER SUSPENSION [ZMAX].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZITHROMYCIN 500MG TABLET (30 CT)  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZITHROMYCIN TABLETS  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT  |
2 |
Preferred Brands |
$40.00 | $100.00 | None |
AZTREONAM FOR INJECTION  |
1* |
Generic Drugs |
$6.00 | $0.00 | None |