2011 Medicare Part D Plan Formulary Information |
UPMC for Life (PDP) (S3389-005-0)
Benefit Details
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The UPMC for Life (PDP) (S3389-005-0) Formulary Drugs Starting with the Letter E in CMS PDP Region 6 which includes: PA WV
|
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ECONAZOLE NITRATE 1% CREAM 85GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover ECONAZOLE NITRATE 1% CREAM 85GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ED K+10 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ED K+10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EDECRIN 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover EDECRIN 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EFFEXOR 37.5MG CAPSULE ER (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover EFFEXOR 37.5MG CAPSULE ER (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | S Q:31 /31Days |
EFFEXOR XR 150MG CAPSULE ER 15 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in PA cover EFFEXOR XR 150MG CAPSULE ER 15 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | S Q:62 /31Days |
EFFEXOR XR 75MG CAPSULE ER 15 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in PA cover EFFEXOR XR 75MG CAPSULE ER 15 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | S Q:93 /31Days |
EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SAFFLOWER OIL 100 MG/ML / SOYBEAN OIL 100 MG/M ![Compare how all Medicare Part D PDP plans in PA cover EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SAFFLOWER OIL 100 MG/ML / SOYBEAN OIL 100 MG/M.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SOYBEAN OIL 100 MG/ML INJECTABLE SUSPENSION [L ![Compare how all Medicare Part D PDP plans in PA cover EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SOYBEAN OIL 100 MG/ML INJECTABLE SUSPENSION [L.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SOYBEAN OIL 200 MG/ML INJECTABLE SUSPENSION [L ![Compare how all Medicare Part D PDP plans in PA cover EGG YOLK PHOSPHOLIPIDS 12 MG/ML / GLYCERIN 25 MG/ML / SOYBEAN OIL 200 MG/ML INJECTABLE SUSPENSION [L.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ELAPRASE 6MG/3ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ELAPRASE 6MG/3ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELESTAT 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover ELESTAT 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ELESTRIN GEL ![Compare how all Medicare Part D PDP plans in PA cover ELESTRIN GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ELIDEL 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover ELIDEL 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P |
ELIGARD 22.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ELIGARD 22.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:1 /84Days |
ELIGARD 30MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ELIGARD 30MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:1 /112Days |
ELIGARD 45MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ELIGARD 45MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:1 /168Days |
ELIGARD 7.5MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ELIGARD 7.5MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:1 /28Days |
ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT ![Compare how all Medicare Part D PDP plans in PA cover ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ELITEK 1.5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ELITEK 1.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
ELIXOPHYLLIN 80MG/15ML ELIX ![Compare how all Medicare Part D PDP plans in PA cover ELIXOPHYLLIN 80MG/15ML ELIX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ELLENCE 2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ELLENCE 2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELMIRON CAPSULES 100MG ![Compare how all Medicare Part D PDP plans in PA cover ELMIRON CAPSULES 100MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ELSPAR INJ 10000UNT ![Compare how all Medicare Part D PDP plans in PA cover ELSPAR INJ 10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
EMADINE 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover EMADINE 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EMCYT 140MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EMCYT 140MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EMEND 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EMEND 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:1 /30Days |
EMEND CAPSULES 125MG 6 BLPK ![Compare how all Medicare Part D PDP plans in PA cover EMEND CAPSULES 125MG 6 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:2 /31Days |
EMEND CAPSULES 80MG 2 BLPK ![Compare how all Medicare Part D PDP plans in PA cover EMEND CAPSULES 80MG 2 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:4 /30Days |
EMEND TRIFOLD PACK ![Compare how all Medicare Part D PDP plans in PA cover EMEND TRIFOLD PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | P Q:6 /28Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H ![Compare how all Medicare Part D PDP plans in PA cover EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H ![Compare how all Medicare Part D PDP plans in PA cover EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H ![Compare how all Medicare Part D PDP plans in PA cover EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMTRIVA 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover EMTRIVA 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EMTRIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EMTRIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ENALAPRIL MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENALAPRIL MALEATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENALAPRIL MALEATE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENALAPRIL MALEATE TABLETS 5MG ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE TABLETS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENBREL 25 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ENBREL 25 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:8 /28Days |
ENBREL 25MG KIT ![Compare how all Medicare Part D PDP plans in PA cover ENBREL 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:8 /28Days |
ENBREL INJECTION 50MG/ML SYR ![Compare how all Medicare Part D PDP plans in PA cover ENBREL INJECTION 50MG/ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENDOCET 10/650MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENDOCET 10/650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENDOCET 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENDOCET 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENDOCET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENDOCET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENDOCET 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENDOCET 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENDOCET 7.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENDOCET 7.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENDODAN TABLETS 325;4.8355MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ENDODAN TABLETS 325;4.8355MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ENGERIX B INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ENGERIX B INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ENGERIX B INJECTION 20MCG/ML ![Compare how all Medicare Part D PDP plans in PA cover ENGERIX B INJECTION 20MCG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ENGERIX-B 10MCG 10 X 0.5ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover ENGERIX-B 10MCG 10 X 0.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ENJUVIA 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENJUVIA 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ENJUVIA 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENJUVIA 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENJUVIA 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENJUVIA 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ENJUVIA 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENJUVIA 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ENJUVIA 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ENJUVIA 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:60 /365Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:60 /365Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:60 /365Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:60 /365Days |
ENTOCORT EC 3MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ENTOCORT EC 3MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL ![Compare how all Medicare Part D PDP plans in PA cover ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPINEPHRINE 0.1MG/ML ABBJCT ![Compare how all Medicare Part D PDP plans in PA cover EPINEPHRINE 0.1MG/ML ABBJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPIPEN 0.3MG AUTO-INJECTOR ![Compare how all Medicare Part D PDP plans in PA cover EPIPEN 0.3MG AUTO-INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPIPEN JR 0.15MG AUTO-INJCT ![Compare how all Medicare Part D PDP plans in PA cover EPIPEN JR 0.15MG AUTO-INJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPIRUBICIN HCL INJECTION SOLUTION 2MG 1 X 25ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover EPIRUBICIN HCL INJECTION SOLUTION 2MG 1 X 25ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPITOL 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EPITOL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPIVIR 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EPIVIR 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPIVIR HBV 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EPIVIR HBV 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPIVIR HBV 25MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in PA cover EPIVIR HBV 25MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPIVIR ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover EPIVIR ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPIVIR TABLETS ![Compare how all Medicare Part D PDP plans in PA cover EPIVIR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EPLERENONE 25MG TABS ![Compare how all Medicare Part D PDP plans in PA cover EPLERENONE 25MG TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPLERENONE 50MG TABS ![Compare how all Medicare Part D PDP plans in PA cover EPLERENONE 50MG TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EPOGEN 10000U/ML VIAL MDV ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN 10000U/ML VIAL MDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPOGEN 2000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN 2000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | P |
EPOGEN 3000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN 3000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | P |
EPOGEN 4000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN 4000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | P |
EPOGEN INJECTION 20000U 10 X 1ML CRTN ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN INJECTION 20000U 10 X 1ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
EPOGEN INJECTION 40000U 10 X 4ML VIALS VIALSD ![Compare how all Medicare Part D PDP plans in PA cover EPOGEN INJECTION 40000U 10 X 4ML VIALS VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
EPZICOM TABLETS ![Compare how all Medicare Part D PDP plans in PA cover EPZICOM TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
EQUETRO CAPSULES 200MG 120 BOT ![Compare how all Medicare Part D PDP plans in PA cover EQUETRO CAPSULES 200MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EQUETRO CAPSULES 300MG 120 BOT ![Compare how all Medicare Part D PDP plans in PA cover EQUETRO CAPSULES 300MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EQUETRO EXTENDED RELEASE CAPSULES 100MG 120 BOT ![Compare how all Medicare Part D PDP plans in PA cover EQUETRO EXTENDED RELEASE CAPSULES 100MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERGOLOID MESYLATES TABLETS 1MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ERGOLOID MESYLATES TABLETS 1MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERGOTAMINE-CAFFEINE 1-100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ERGOTAMINE-CAFFEINE 1-100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERRIN 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ERRIN 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERY 2% PADS 2% 60 PADS JAR ![Compare how all Medicare Part D PDP plans in PA cover ERY 2% PADS 2% 60 PADS JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERY DELAYED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ERY DELAYED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERY TAB TABLETS 333MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ERY TAB TABLETS 333MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERY-TAB 500MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover ERY-TAB 500MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERYPED 200MG/5ML 100 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover ERYPED 200MG/5ML 100 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERYPED POWDER FOR ORAL SOLUTION 400MG/5ML 100 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover ERYPED POWDER FOR ORAL SOLUTION 400MG/5ML 100 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERYTHROCIN 500MG ADDVNT VL ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROCIN 500MG ADDVNT VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ERYTHROCIN 500MG FILMTAB ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROCIN 500MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROCIN STEARATE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROCIN STEARATE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN 2% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN 2% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERYTHROMYCIN 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN 500MG FILMTAB ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN 500MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN ETHYLSUCCINATE AND SULFISOXAZOLE ACETYL POWDER FOR ORAL SUSPENSION 200;600MG/5ML;MG/ 10 ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN ETHYLSUCCINATE AND SULFISOXAZOLE ACETYL POWDER FOR ORAL SUSPENSION 200;600MG/5ML;MG/ 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN GEL TOPICAL USP 2% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN GEL TOPICAL USP 2% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ERYTHROMYCIN-BENZOYL PEROXIDE 3-5% GEL ![Compare how all Medicare Part D PDP plans in PA cover ERYTHROMYCIN-BENZOYL PEROXIDE 3-5% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRACE VAG CREAM 0.1MG/GM ![Compare how all Medicare Part D PDP plans in PA cover ESTRACE VAG CREAM 0.1MG/GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
ESTRADIOL 0.05MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL 0.05MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
ESTRADIOL 0.1MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL 0.1MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | Q:4 /28Days |
ESTRADIOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL TABLET 1MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL TABLET 1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRADIOL-NORETH 1.0-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTRADIOL-NORETH 1.0-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTRING 2MG VAGINAL RING ![Compare how all Medicare Part D PDP plans in PA cover ESTRING 2MG VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
ESTROPIPATE 0.625 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTROPIPATE 0.625 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTROPIPATE 1.25 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTROPIPATE 1.25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ESTROPIPATE 2.5 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ESTROPIPATE 2.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHAMBUTOL HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ETHAMBUTOL HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHAMBUTOL HCL 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ETHAMBUTOL HCL 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6 ![Compare how all Medicare Part D PDP plans in PA cover ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21 ![Compare how all Medicare Part D PDP plans in PA cover ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHOSUXIMIDE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ETHOSUXIMIDE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETHOSUXIMIDE 250MG/5ML SYRP ![Compare how all Medicare Part D PDP plans in PA cover ETHOSUXIMIDE 250MG/5ML SYRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETIDRONATE DISODIUM 400MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover ETIDRONATE DISODIUM 400MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETIDRONATE DISODIUM TABLETS 200MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover ETIDRONATE DISODIUM TABLETS 200MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETODOLAC 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 400MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 400MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
ETODOLAC 600MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover ETODOLAC 600MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |
EVAMIST 1.53/SPRAY SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in PA cover EVAMIST 1.53/SPRAY SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EVOXAC 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EVOXAC 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | Q:93 /31Days |
EXELON 1.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EXELON 1.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EXELON 2MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover EXELON 2MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EXELON 3MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EXELON 3MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXELON 4.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EXELON 4.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in PA cover EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXELON 6MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover EXELON 6MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$86.00 | $258.00 | None |
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in PA cover EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXFORGE 10MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXFORGE 10MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXFORGE 10MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXFORGE 10MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXFORGE 5MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXFORGE 5MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXFORGE 5MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXFORGE 5MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$38.00 | $95.00 | None |
EXJADE 125MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXJADE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
EXJADE 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXJADE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
EXJADE 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover EXJADE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXTENDED PHENYTOIN SODIUM CAPSULES 300 MG ![Compare how all Medicare Part D PDP plans in PA cover EXTENDED PHENYTOIN SODIUM CAPSULES 300 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$5.00 | $10.00 | None |