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2011 Medicare Part D and Medicare Advantage Plan Formulary Browser

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Aetna Medicare Rx Costco Plus Plan (PDP) (S5810-236-0)
Tier 1 (1457)
Tier 2 (610)
Tier 3 (258)
Tier 4 (540)
Tier 5 (315)
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
Aetna Medicare Rx Costco Plus Plan (PDP) (S5810-236-0)
Sanctioned Plan           
The Aetna Medicare Rx Costco Plus Plan (PDP) (S5810-236-0)
Formulary Drugs Starting with the Letter A

in CMS PDP Region 32 which includes: CA
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 Tier 1 $2.00$12.00None
A-HYDROCORT 100MG VIAL   1 Tier 1 $2.00$12.00None
A-METHAPRED 40MG UNIVIAL   1 Tier 1 $2.00$12.00None
ABILIFY 10MG TABLET   4 Tier 4 $60.00$180.00P S Q:1
/1Days
ABILIFY 15MG TABLET   4 Tier 4 $60.00$180.00P S Q:1
/1Days
ABILIFY 1MG/ML SOLUTION   4 Tier 4 $60.00$180.00P S Q:30
/1Days
ABILIFY 20MG TABLET   4 Tier 4 $60.00$180.00P S Q:1
/1Days
ABILIFY 2MG TABLET   4 Tier 4 $60.00$180.00P S Q:1
/1Days
ABILIFY 30MG TABLET   4 Tier 4 $60.00$180.00P S Q:1
/1Days
ABILIFY 5MG TABLET (OTSUKA)   4 Tier 4 $60.00$180.00P S Q:1
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ABILIFY DISCMELT 10MG TABLET   4 Tier 4 $60.00$180.00P S Q:2
/1Days
ABILIFY DISCMELT 15MG TABLET   4 Tier 4 $60.00$180.00P S Q:2
/1Days
ABILIFY INJ 9.75MG   4 Tier 4 $60.00$180.00Q:4
/1Days
ACARBOSE 100MG TABLET S   2 Tier 2 $20.00$60.00Q:3
/1Days
ACARBOSE 50MG TABLET S   2 Tier 2 $20.00$60.00Q:3
/1Days
ACARBOSE TABLETS   2 Tier 2 $20.00$60.00Q:3
/1Days
ACCOLATE 10MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
ACCOLATE 20MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
ACEBUTOLOL 200MG CAPSULE   1 Tier 1 $2.00$12.00None
ACEBUTOLOL 400MG CAPSULE   1 Tier 1 $2.00$12.00None
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE   4 Tier 4 $60.00$180.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD   1 Tier 1 $2.00$12.00Q:167
/1Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)   1 Tier 1 $2.00$12.00Q:13
/1Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT)   1 Tier 1 $2.00$12.00Q:13
/1Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)   1 Tier 1 $2.00$12.00Q:13
/1Days
ACETAMINOPHEN CAFFEINE AND DIHYDROCODEINE BITARTRATE TABLETS 712.8;60;MG;MG;MG 100 BOT   2 Tier 2 $20.00$60.00Q:5
/1Days
ACETASOL HC SOLUTION 10ML 10 ML BOT   1 Tier 1 $2.00$12.00None
ACETAZOLAMIDE 125MG TABLET   1 Tier 1 $2.00$12.00None
ACETAZOLAMIDE 250MG TABLET (100 CT)   1 Tier 1 $2.00$12.00None
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT   1 Tier 1 $2.00$12.00None
ACETAZOLAMIDE SOD 500MG VL   2 Tier 2 $20.00$60.00None
ACETIC ACID 2% SOLUTION NON-ORAL   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETYLCYSTEINE 10% VIAL   1 Tier 1 $2.00$12.00P
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN   1 Tier 1 $2.00$12.00P
ACLOVATE ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT(GM) TOPICAL   2 Tier 2 $20.00$60.00None
ACLOVATE CREAM 0.05% 15GM TUBE   1 Tier 1 $2.00$12.00None
ACTEMRA INJECTION 200MG/10ML   5 Tier 5 25%25%P
ACTHIB VACCINE VIAL 10-24UNT/5ML   3 Tier 3 $25.00$75.00None
ACTICIN 5% CREAM   1 Tier 1 $2.00$12.00None
ACTIMMUNE SOLUTION FOR INJECTION 100MCG   5 Tier 5 25%25%P
ACTOPLUS MET 15MG/500MG TABLET   3 Tier 3 $25.00$75.00Q:3
/1Days
ACTOPLUS MET 15MG/850MG TABLET   3 Tier 3 $25.00$75.00Q:3
/1Days
ACTOS 15MG TABLET   3 Tier 3 $25.00$75.00Q:1
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACTOS 30MG TABLET (500 CT)   3 Tier 3 $25.00$75.00Q:1
/1Days
ACTOS 45MG TABLET   3 Tier 3 $25.00$75.00Q:1
/1Days
ACYCLOVIR 200MG CAPSULE (1000 CT)   1 Tier 1 $2.00$12.00None
ACYCLOVIR 200MG/5ML SUSP   2 Tier 2 $20.00$60.00None
ACYCLOVIR 400MG TABLET (100 CT)   1 Tier 1 $2.00$12.00None
ACYCLOVIR 800 MG ORAL TABLET   1 Tier 1 $2.00$12.00None
ACYCLOVIR SODIUM 500MG VIAL   2 Tier 2 $20.00$60.00None
ADACEL VIAL 2UNT/5UNT   4 Tier 4 $60.00$180.00None
ADAGEN 250U/ML VIAL   5 Tier 5 25%25%None
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]   5 Tier 5 25%25%P Q:2
/28Days
ADAPALENE CREAM   2 Tier 2 $20.00$60.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADAPALENE GEL   2 Tier 2 $20.00$60.00None
ADOXA 100MG TABLET   2 Tier 2 $20.00$60.00P
ADOXA 50MG TABLET   2 Tier 2 $20.00$60.00P
ADOXA PAK 100MG TABLET DSPK-31   2 Tier 2 $20.00$60.00P
ADOXA PAK 100MG TABLET DSPK-60   2 Tier 2 $20.00$60.00P
ADOXA PAK 150MG TABLET   2 Tier 2 $20.00$60.00P
ADVAIR DISKU MIS 100/50   3 Tier 3 $25.00$75.00Q:2
/1Days
ADVAIR DISKU MIS 250/50   3 Tier 3 $25.00$75.00Q:2
/1Days
ADVAIR DISKU MIS 500/50   3 Tier 3 $25.00$75.00Q:2
/1Days
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   3 Tier 3 $25.00$75.00Q:12
/25Days
ADVAIR HFA INHALER 230;21MCG;MCG   3 Tier 3 $25.00$75.00Q:12
/25Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   3 Tier 3 $25.00$75.00Q:12
/25Days
AFEDITAB CR 30MG TABLET SA   1 Tier 1 $2.00$12.00Q:1
/1Days
AFEDITAB CR 60MG TABLET SA   1 Tier 1 $2.00$12.00Q:2
/1Days
AFINITOR TABLETS   5 Tier 5 25%25%P Q:2
/1Days
AFINITOR TABLETS   5 Tier 5 25%25%P Q:1
/1Days
AFINITOR TABLETS 5 MG   5 Tier 5 25%25%P Q:3
/1Days
AGGRENOX 25-200MG CAPSULE   3 Tier 3 $25.00$75.00Q:2
/1Days
AK-CON 0.1% EYE DROPS   1 Tier 1 $2.00$12.00None
AKTOB 0.3% EYE DROPS   1 Tier 1 $2.00$12.00None
ALA-CORT 1% CREAM   1 Tier 1 $2.00$12.00None
ALA-CORT 1% LOTION   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALA-SCALP HP 2% LOTION   2 Tier 2 $20.00$60.00None
ALBENZA 200MG TABLET   4 Tier 4 $60.00$180.00None
ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER   1 Tier 1 $2.00$12.00P
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   1 Tier 1 $2.00$12.00P
ALBUTEROL SULFATE 4MG TABLET SR 12HR   2 Tier 2 $20.00$60.00None
ALBUTEROL SULFATE 8MG TABLET SR 12HR   2 Tier 2 $20.00$60.00None
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   1 Tier 1 $2.00$12.00P
ALBUTEROL SULFATE SOLUTION FOR INHALATION   1 Tier 1 $2.00$12.00P
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   1 Tier 1 $2.00$12.00None
ALBUTEROL SULFATE TABLET 2MG (500 CT)   1 Tier 1 $2.00$12.00None
ALBUTEROL TABLET 4MG (500 CT)   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALCAINE 0.5% EYE DROPS   1 Tier 1 $2.00$12.00None
ALCLOMETASONE DIPROPIONATE 0.05% CREAM   1 Tier 1 $2.00$12.00None
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT   1 Tier 1 $2.00$12.00None
ALCOHOL 5%/DEXTROSE 5%   1 Tier 1 $2.00$12.00None
ALDARA IMIQUIMOD CREAM 5% 24 PKT X 250 MG CRTN   4 Tier 4 $60.00$180.00Q:12
/30Days
ALDURAZYME 2.9MG/5ML VIAL   5 Tier 5 25%25%None
ALENDRONATE SODIUM 10MG TABLET   1 Tier 1 $2.00$12.00Q:1
/1Days
ALENDRONATE SODIUM 40MG TABLET   1 Tier 1 $2.00$12.00Q:1
/1Days
ALENDRONATE SODIUM 5MG TABLET   1 Tier 1 $2.00$12.00Q:1
/1Days
ALENDRONATE SODIUM TABLET 35MG 20 CRTN   1 Tier 1 $2.00$12.00Q:4
/28Days
ALENDRONATE SODIUM TABLETS 70 MG   1 Tier 1 $2.00$12.00Q:4
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALIMTA 500MG VIAL   5 Tier 5 25%25%P
ALINIA 100MG/5ML SUSPENSION   4 Tier 4 $60.00$180.00Q:50
/1Days
ALINIA 500MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
ALISKIREN 150 MG / VALSARTAN 160 MG ORAL TABLET [VALTURNA]   3 Tier 3 $25.00$75.00Q:1
/1Days
ALISKIREN 300 MG / VALSARTAN 320 MG ORAL TABLET [VALTURNA]   3 Tier 3 $25.00$75.00None
ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU   5 Tier 5 25%25%P
ALLOPURINOL SODIUM 500MG VIAL   2 Tier 2 $20.00$60.00None
ALLOPURINOL TABLET 300MG (1000 CT)   1 Tier 1 $2.00$12.00None
ALLOPURINOL TABLETS   1 Tier 1 $2.00$12.00None
ALPHA-1-PROTEINASE INHIBITOR,HUMAN 16 MG/ML INJECTABLE SOLUTION [ARALAST]   5 Tier 5 25%25%None
ALPHAGAN P 0.1% DROPS   3 Tier 3 $25.00$75.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALPHAGAN P 0.15% EYE DROPS   3 Tier 3 $25.00$75.00None
ALREX 0.2% EYE DROPS   3 Tier 3 $25.00$75.00None
AMANTADINE 100MG CAPSULE   1 Tier 1 $2.00$12.00None
AMANTADINE 100MG TABLET   1 Tier 1 $2.00$12.00None
AMANTADINE HCL 50 MG/ 5 ML SYRUP   2 Tier 2 $20.00$60.00None
AMCINONIDE 0.1% CREAM   1 Tier 1 $2.00$12.00None
AMCINONIDE 0.1% LOTION   1 Tier 1 $2.00$12.00None
AMCINONIDE 0.1% OINTMENT 60GM TUBE   1 Tier 1 $2.00$12.00None
AMEVIVE ADMISTRATION PACK FOR INTRAMUSCULAR ADMINISTRATION KIT 15MG 1 X 4 PKGCOM   5 Tier 5 25%25%Q:4
/28Days
AMIFOSTINE FOR INJECTION 500MG/VIAL   5 Tier 5 25%25%P
AMIKACIN 250MG/ML VIAL   2 Tier 2 $20.00$60.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIKACIN 50MG/ML VIAL   1 Tier 1 $2.00$12.00None
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET   1 Tier 1 $2.00$12.00None
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT   1 Tier 1 $2.00$12.00None
AMINOPHYLLINE 100MG TABLET   1 Tier 1 $2.00$12.00None
AMINOPHYLLINE 200MG TABLET (1000 CT)   1 Tier 1 $2.00$12.00None
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD   1 Tier 1 $2.00$12.00None
AMINOSYN 10% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN 3.5% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN 5% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN 7% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN 7%-ELECTROLYTE SOL   4 Tier 4 $60.00$180.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN 8.5% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN HBC INJECTION SULFITE FREE 7%   4 Tier 4 $60.00$180.00P
AMINOSYN II 10% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN II 15% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN II 3.5% IN D25W IV   4 Tier 4 $60.00$180.00P
AMINOSYN II 3.5% IN D5W IV   4 Tier 4 $60.00$180.00P
AMINOSYN II 3.5% M/D5W IV   4 Tier 4 $60.00$180.00P
AMINOSYN II 3.5% W/ELEC DEX   4 Tier 4 $60.00$180.00P
AMINOSYN II 4.25% IN D10W   4 Tier 4 $60.00$180.00P
AMINOSYN II 4.25% IN D20W   4 Tier 4 $60.00$180.00P
AMINOSYN II 4.25% W/ELEC DW   4 Tier 4 $60.00$180.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN II 4.25%-D25W IV   4 Tier 4 $60.00$180.00P
AMINOSYN II 5% IN D25W IV   4 Tier 4 $60.00$180.00P
AMINOSYN II 7% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN II 8.5% ELECTROLYT   4 Tier 4 $60.00$180.00P
AMINOSYN II 8.5% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN M 3.5% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN PF INJECTION   4 Tier 4 $60.00$180.00P
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   4 Tier 4 $60.00$180.00P
AMINOSYN-HF 8% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMINOSYN-PF 7% IV SOLUTION   4 Tier 4 $60.00$180.00P
AMIODARONE HCL 400MG TABLET   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIODARONE HCL INJECTION   1 Tier 1 $2.00$12.00None
AMIODARONE HYDROCHLORIDE TABLETS   1 Tier 1 $2.00$12.00None
AMITIZA 8MCG CAPSULE   4 Tier 4 $60.00$180.00P S Q:60
/30Days
AMITIZA CAPSULES 24MCG 60 CAP BOT   4 Tier 4 $60.00$180.00S Q:60
/30Days
AMITRIP/CDP 25-10 TABLET   1 Tier 1 $2.00$12.00None
AMITRIP/PERPHEN 10-2 TABLET   1 Tier 1 $2.00$12.00None
AMITRIP/PERPHEN 10-4 TABLET   1 Tier 1 $2.00$12.00None
AMITRIP/PERPHEN 25-2 TABLET   1 Tier 1 $2.00$12.00None
AMITRIP/PERPHEN 25-4 TABLET   1 Tier 1 $2.00$12.00None
AMITRIP/PERPHEN 50-4 TABLET   1 Tier 1 $2.00$12.00None
AMITRIPTYLINE HCL 100MG TABLET   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMITRIPTYLINE HCL 10MG TABLET   1 Tier 1 $2.00$12.00None
AMITRIPTYLINE HCL 150 MG TAB   1 Tier 1 $2.00$12.00None
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)   1 Tier 1 $2.00$12.00None
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)   1 Tier 1 $2.00$12.00None
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT   1 Tier 1 $2.00$12.00None
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/12   3 Tier 3 $25.00$75.00Q:1
/1Days
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/25]   3 Tier 3 $25.00$75.00Q:1
/1Days
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 320 MG ORAL TABLET [EXFORGE HCT 10/320/25]   3 Tier 3 $25.00$75.00None
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/12.5   3 Tier 3 $25.00$75.00Q:1
/1Days
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/25]   3 Tier 3 $25.00$75.00Q:1
/1Days
AMLODIPINE BESYLATE 10MG TABLET (90 CT)   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)   1 Tier 1 $2.00$12.00Q:1
/1Days
AMLODIPINE BESYLATE 5MG TABLET (90 CT)   1 Tier 1 $2.00$12.00Q:1
/1Days
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   2 Tier 2 $20.00$60.00None
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   2 Tier 2 $20.00$60.00None
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE   2 Tier 2 $20.00$60.00None
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE   2 Tier 2 $20.00$60.00None
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE   2 Tier 2 $20.00$60.00None
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE   2 Tier 2 $20.00$60.00None
AMMONIUM CHLORIDE 5 MEQ/ML   1 Tier 1 $2.00$12.00None
AMMONIUM LACTATE 12% CREAM   1 Tier 1 $2.00$12.00None
AMMONIUM LACTATE 12% LOTION   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMNESTEEM 10MG CAPSULE   2 Tier 2 $20.00$60.00P
AMNESTEEM 20MG CAPSULE   2 Tier 2 $20.00$60.00P
AMNESTEEM 40MG CAPSULE   2 Tier 2 $20.00$60.00P
AMOX TR-K CLV 500-125 MG TAB   1 Tier 1 $2.00$12.00None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL   1 Tier 1 $2.00$12.00None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE   1 Tier 1 $2.00$12.00None
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET   1 Tier 1 $2.00$12.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE   1 Tier 1 $2.00$12.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL   1 Tier 1 $2.00$12.00None
AMOXAPINE 100MG TABLET   1 Tier 1 $2.00$12.00None
AMOXAPINE 150MG TABLET   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXAPINE 25MG TABLET   1 Tier 1 $2.00$12.00None
AMOXAPINE 50MG TABLET   1 Tier 1 $2.00$12.00None
AMOXICILLIN 125MG TABLET CHEW   1 Tier 1 $2.00$12.00None
AMOXICILLIN 200MG TABLET CHEW   1 Tier 1 $2.00$12.00None
AMOXICILLIN 250MG CAPSULE   1 Tier 1 $2.00$12.00None
AMOXICILLIN 400MG TABLET CHEW   1 Tier 1 $2.00$12.00None
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION   1 Tier 1 $2.00$12.00None
AMOXICILLIN 500MG CAPSULE   1 Tier 1 $2.00$12.00None
AMOXICILLIN 500MG TABLET (100 CT)   1 Tier 1 $2.00$12.00None
AMOXICILLIN 875MG TABLET   1 Tier 1 $2.00$12.00None
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT   1 Tier 1 $2.00$12.00None
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   2 Tier 2 $20.00$60.00None
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT   1 Tier 1 $2.00$12.00None
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT   1 Tier 1 $2.00$12.00None
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL   1 Tier 1 $2.00$12.00None
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Tier 1 $2.00$12.00None
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL   1 Tier 1 $2.00$12.00None
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT)   1 Tier 1 $2.00$12.00None
AMPHETAMINE SALT COMBO 12.5MG TABLET   1 Tier 1 $2.00$12.00P Q:2
/1Days
AMPHETAMINE SALT COMBO 15MG TABLET   1 Tier 1 $2.00$12.00P Q:2
/1Days
AMPHETAMINE SALT COMBO 30MG TABLET   1 Tier 1 $2.00$12.00P Q:2
/1Days
AMPHETAMINE SALT COMBO 7.5MG TABLET   1 Tier 1 $2.00$12.00P Q:2
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPHETAMINE SALTS 20MG TABLET   1 Tier 1 $2.00$12.00P Q:3
/1Days
AMPHETAMINE SALTS 5 MG TAB   1 Tier 1 $2.00$12.00P Q:2
/1Days
AMPHOTERICIN B FOR INJECTION 50 MG   2 Tier 2 $20.00$60.00None
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL   2 Tier 2 $20.00$60.00None
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL   2 Tier 2 $20.00$60.00None
AMPICILLIN CAPSULES 250MG 100 BOT   1 Tier 1 $2.00$12.00None
AMPICILLIN CAPSULES 500MG 100 BOT   1 Tier 1 $2.00$12.00None
AMPICILLIN FOR INJECTION POWDER   2 Tier 2 $20.00$60.00None
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL   2 Tier 2 $20.00$60.00None
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT   1 Tier 1 $2.00$12.00None
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPICILLIN POWDER FOR INJECTION 1 GM/ML   2 Tier 2 $20.00$60.00None
AMPYRA ER 10 MG TABLET   5 Tier 5 25%25%P Q:2
/1Days
ANADROL-50 50MG TABLET (100 CT)   5 Tier 5 25%25%P
ANAGRELIDE HCL 0.5MG CAPSULE   2 Tier 2 $20.00$60.00None
ANAGRELIDE HCL 1MG CAPSULE   2 Tier 2 $20.00$60.00None
ANASTROZOLE TABLETS   2 Tier 2 $20.00$60.00Q:1
/1Days
ANCOBON 250MG CAPSULE   5 Tier 5 25%25%None
ANCOBON 500MG CAPSULE   5 Tier 5 25%25%None
ANDRODERM 2.5MG/24HR PATCH   3 Tier 3 $25.00$75.00Q:2
/1Days
ANDRODERM 5MG/24HR PATCH   3 Tier 3 $25.00$75.00Q:1
/1Days
ANDROGEL 1%(50MG) GEL PACKET   3 Tier 3 $25.00$75.00Q:10
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ANDROID 10MG CAPSULE   2 Tier 2 $20.00$60.00None
ANESTACON 15ML   1 Tier 1 $2.00$12.00None
ANTABUSE 250MG TABLET   2 Tier 2 $20.00$60.00None
ANTABUSE 500MG TABLET   2 Tier 2 $20.00$60.00None
ANUSOL-HC 2.5% CREAM   2 Tier 2 $20.00$60.00None
ANZEMET 100MG TABLET   5 Tier 5 25%25%P S Q:5
/30Days
ANZEMET 50MG TABLET   4 Tier 4 $60.00$180.00P S Q:5
/30Days
APAP-CAFFEINE-DIHYDROCODE TAB 30 EA   2 Tier 2 $20.00$60.00Q:5
/1Days
APHTHASOL 5% PASTE   4 Tier 4 $60.00$180.00None
APOKYN 30 MG/3 ML CARTRIDGE   5 Tier 5 25%25%P
APRACLONIDINE 5 MG/ML OPHTHALMIC SOLUTION   2 Tier 2 $20.00$60.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
APRI 0.15-0.03 TABLET   1 Tier 1 $2.00$12.00None
APTIVUS 250MG CAPSULE   5 Tier 5 25%25%None
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   5 Tier 5 25%25%None
ARANELLE 7-9-5 TABLET   1 Tier 1 $2.00$12.00None
ARANESP 100MCG/ML VIAL   5 Tier 5 25%25%P
ARANESP 200MCG/0.4ML SYRINGE   5 Tier 5 25%25%P
ARANESP 200MCG/ML VIAL   5 Tier 5 25%25%P
ARANESP 25MCG/ML VIAL   3 Tier 3 $25.00$75.00P
ARANESP 300MCG/ML VIAL   5 Tier 5 25%25%P
ARANESP 500MCG/1ML SYRINGE   5 Tier 5 25%25%P
ARANESP 60MCG/ML VIAL   5 Tier 5 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARANESP PREFILLED SYRINGE SINGLE USE 100MCG/0.5ML 1 SYR   5 Tier 5 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR   5 Tier 5 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR   3 Tier 3 $25.00$75.00P
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR   5 Tier 5 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR   3 Tier 3 $25.00$75.00P
ARANESP PREFILLED SYRINGE SINGLE USE 60MCG/0.3ML 60MCG/ 0.3ML SYR   5 Tier 5 25%25%P
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD   3 Tier 3 $25.00$75.00P
ARCALYST INJECTION 220MG/VIAL   5 Tier 5 25%25%P
ARIMIDEX 1MG TABLET   4 Tier 4 $60.00$180.00Q:1
/1Days
ARIXTRA 10MG SYRINGE   5 Tier 5 25%25%None
ARIXTRA 2.5MG SYRINGE   4 Tier 4 $60.00$180.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARIXTRA 5MG SYRINGE   5 Tier 5 25%25%None
ARIXTRA 7.5MG SYRINGE   5 Tier 5 25%25%None
AROMASIN 25MG TABLET   4 Tier 4 $60.00$180.00None
ARZERRA INJECTION 100MG/5ML   5 Tier 5 25%25%P
ASACOL 400MG TABLET EC   4 Tier 4 $60.00$180.00Q:12
/1Days
ASACOL HD DELAYED RELEASE TABLETS 800MG 180 BOT   4 Tier 4 $60.00$180.00Q:6
/1Days
ASCOMP W/CODEINE 30-50-325 CAPSULE   2 Tier 2 $20.00$60.00Q:6
/1Days
ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS]   4 Tier 4 $60.00$180.00Q:2
/1Days
ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS]   4 Tier 4 $60.00$180.00Q:2
/1Days
ASMANEX 220MCG(14) AEROSOL POWDER BREATH ACTIVATED   3 Tier 3 $25.00$75.00Q:1
/30Days
ASMANEX TWISTHALER 110 MCG #30   3 Tier 3 $25.00$75.00Q:135
/25Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ASMANEX TWISTHALER 220MCG #120   3 Tier 3 $25.00$75.00Q:1
/30Days
ASMANEX TWISTHALER 220MCG #30   3 Tier 3 $25.00$75.00Q:1
/30Days
ASMANEX TWISTHALER 220MCG #60   3 Tier 3 $25.00$75.00Q:1
/30Days
ASTRAMORPH PF INJECTION   1 Tier 1 $2.00$12.00None
ASTRAMORPH PF INJECTION 1MG/ML   1 Tier 1 $2.00$12.00None
ATAMET   1 Tier 1 $2.00$12.00None
ATENOLOL 25MG TABLET (100 CT)   1 Tier 1 $2.00$12.00None
ATENOLOL TABLET USP 50MG (100 CT)   1 Tier 1 $2.00$12.00None
ATENOLOL TABLETS USP 100MG 1 BLPK   1 Tier 1 $2.00$12.00None
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT)   1 Tier 1 $2.00$12.00None
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATGAM 50MG/ML AMPUL   5 Tier 5 25%25%P
ATRIPLA TABLET 600MG/200MG   5 Tier 5 25%25%None
ATROPINE 0.025 MG / DIPHENOXYLATE 2.5 MG ORAL TABLET   1 Tier 1 $2.00$12.00P
ATROPINE 0.05MG/ML SYRINGE   1 Tier 1 $2.00$12.00P
ATROPINE 0.1MG/ML SYRINGE   1 Tier 1 $2.00$12.00P
ATROVENT HFA AER 17MCG   4 Tier 4 $60.00$180.00Q:1
/1Days
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML   4 Tier 4 $60.00$180.00None
AVANDAMET 2MG/1000MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
AVANDAMET 2MG/500MG TABLET   4 Tier 4 $60.00$180.00Q:4
/1Days
AVANDAMET 4MG/500MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
AVANDAMET TABLET 4-1000MG   4 Tier 4 $60.00$180.00Q:2
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVANDARYL 4MG/1MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
AVANDARYL 4MG/2MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
AVANDARYL 4MG/4MG TABLET   4 Tier 4 $60.00$180.00Q:2
/1Days
AVANDARYL 8MG-2MG TABLET   4 Tier 4 $60.00$180.00Q:1
/1Days
AVANDARYL 8MG-4MG TABLET   4 Tier 4 $60.00$180.00Q:1
/1Days
AVANDIA 2MG TABLET   4 Tier 4 $60.00$180.00Q:1
/1Days
AVANDIA 4MG TABLET (90 CT)   4 Tier 4 $60.00$180.00Q:1
/1Days
AVANDIA 8MG TABLET (90 CT)   4 Tier 4 $60.00$180.00Q:1
/1Days
AVASTIN 100MG/4ML VIAL   5 Tier 5 25%25%P
AVELOX 400MG TABLET   4 Tier 4 $60.00$180.00None
AVELOX ABC PACK 400MG TABLET   4 Tier 4 $60.00$180.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVELOX IV 400MG/250ML   4 Tier 4 $60.00$180.00None
AVIANE 0.1-0.02 TABLET   1 Tier 1 $2.00$12.00None
AVITA 0.025% CREAM   1 Tier 1 $2.00$12.00P
AVODART 0.5MG SOFTGEL   3 Tier 3 $25.00$75.00P Q:1
/1Days
AVONEX ADMIN PACK 30MCG SYR   5 Tier 5 25%25%P Q:4
/28Days
AVONEX ADMIN PACK 30MCG VL   5 Tier 5 25%25%P Q:4
/28Days
AZACTAM INJECTION   3 Tier 3 $25.00$75.00None
AZACTAM INJECTION 1GM/50ML   3 Tier 3 $25.00$75.00None
AZACTAM INJECTION 2GM/VIL   3 Tier 3 $25.00$75.00None
AZASAN 100MG TABLET   2 Tier 2 $20.00$60.00P
AZASAN 75MG TABLET   2 Tier 2 $20.00$60.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZASITE 1% DROPS   3 Tier 3 $25.00$75.00None
AZATHIOPRINE 50MG TABLET   1 Tier 1 $2.00$12.00P
AZATHIOPRINE SOD 100MG VIAL   5 Tier 5 25%25%P
AZELASTINE 137 MCG NASAL SPRAY   2 Tier 2 $20.00$60.00None
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION   2 Tier 2 $20.00$60.00None
AZELEX 20% CREAM 30GM TUBE   4 Tier 4 $60.00$180.00None
AZILECT 0.5MG TABLET   3 Tier 3 $25.00$75.00None
AZILECT 1MG TABLET   3 Tier 3 $25.00$75.00None
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Tier 1 $2.00$12.00None
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Tier 1 $2.00$12.00None
AZITHROMYCIN 250 MG TABLET   1 Tier 1 $2.00$12.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZITHROMYCIN 33.3 MG/ML ER SUSPENSION [ZMAX]   4 Tier 4 $60.00$180.00None
AZITHROMYCIN 500MG TABLET (30 CT)   1 Tier 1 $2.00$12.00None
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD   2 Tier 2 $20.00$60.00None
AZITHROMYCIN TABLETS   1 Tier 1 $2.00$12.00None
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT   4 Tier 4 $60.00$180.00None
AZTREONAM FOR INJECTION   2 Tier 2 $20.00$60.00None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D Aetna Medicare Rx Costco Plus Plan (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 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 wit 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 which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $(2840)) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, on the 2011 Humana Walmart-Preferred Rx Plan the pricing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2011 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.