Q1Medicare.com 2011 Medicare Part D or Medicare Advantage Plan Formulary Browser

2011 Medicare Part D Plan Formulary Information
Community CCRx Choice (PDP) (S5803-139-0) Benefit Details
The Community CCRx Choice (PDP) (S5803-139-0) Formulary Drugs Starting with the Letter N in CMS PDP Region 2 which includes: CT MA RI VT
Drugs Starting with Letter N Drug Name	Drug Tier Information		Cost-Sharing		Drug Usage Mgmt
Drugs Starting with Letter N Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NABUMETONE 500MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NABUMETONE 750MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NADOLOL 20MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NADOLOL TABLETS	1	Generic and Preferred Brand	$0.00	N/A	None
NADOLOL TABLETS	1	Generic and Preferred Brand	$0.00	N/A	None
NAFAZAIR 0.1% EYE DROPS	1	Generic and Preferred Brand	$0.00	N/A	None
NAFCILLIN FOR INJECTION 1 GM/ML	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NAGLAZYME 5MG/5ML VIAL	4	Specialty Tier	33%	N/A	P
NALOXONE 1MG/ML SYRINGE	1	Generic and Preferred Brand	$0.00	N/A	None
NALOXONE HCL INJECTION 0.4MG 10 X 1ML CTG	1	Generic and Preferred Brand	$0.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NALTREXONE HCL 50MG TABLET 100 BLPK	1	Generic and Preferred Brand	$0.00	N/A	None
NAMENDA 10MG TABLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:60 /30Days
NAMENDA 10MG/5ML SOLUTION	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	P Q:360 /30Days
NAMENDA 5-10MG TITRATION PK	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:49 /365Days
NAMENDA 5MG TABLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:60 /30Days
NAPROXEN 125MG/5ML SUSPEN	1	Generic and Preferred Brand	$0.00	N/A	None
NAPROXEN 250 MG ORAL TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NAPROXEN 375MG TABLET EC	1	Generic and Preferred Brand	$0.00	N/A	None
NAPROXEN 500MG TABLET EC	1	Generic and Preferred Brand	$0.00	N/A	None
NAPROXEN SODIUM 275 MG ORAL TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NAPROXEN SODIUM 550 MG ORAL TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NAPROXEN TABLET 375MG (500 CT)	1	Generic and Preferred Brand	$0.00	N/A	None
NARATRIPTAN TABLETS	1	Generic and Preferred Brand	$0.00	N/A	Q:12 /30Days
NARATRIPTAN TABLETS	1	Generic and Preferred Brand	$0.00	N/A	Q:12 /30Days
NARDIL 15MG TABLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NASONEX 50MCG NASAL SPRAY	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:34 /30Days
NATACYN EYE DROPS	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NATEGLINIDE 120 MG ORAL TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:90 /30Days
NATEGLINIDE 60 MG ORAL TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:90 /30Days
NAVANE 20MG CAPSULE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NECON 0.5/35-28 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NECON 1/35-28 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NECON 10/11-28 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NECON 7 DAYS X 3 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NEFAZODONE HCL 150MG TABLET (60 CT)	1	Generic and Preferred Brand	$0.00	N/A	None
NEFAZODONE HCL 250MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NEFAZODONE HCL 50MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT	1	Generic and Preferred Brand	$0.00	N/A	None
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT	1	Generic and Preferred Brand	$0.00	N/A	None
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN AND POLYMYXIN B SULFATES AND DEXAMETHASONE OPHTHALMIC OINTMENT	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN SULFATE 500MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT	1	Generic and Preferred Brand	$0.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN/POLYMY/DEXA EYE DROPS 3.5MG/1ML	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M	1	Generic and Preferred Brand	$0.00	N/A	None
NEOMYCIN/POLYMY/HYDRO OTIC SUS	1	Generic and Preferred Brand	$0.00	N/A	None
NEORAL 100MG GELATN CAPSULE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	P
NEORAL 100MG/ML SOLUTION	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	P
NEORAL 25MG GELATIN CAPSULE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	P
NEPHRAMINE SOLUTION FOR INJECTION	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	P
NEULASTA 6MG/0.6ML SYRINGE	4	Specialty Tier	33%	N/A	P S Q:1 /28Days
NEUPOGEN 300MCG/ML VIAL	4	Specialty Tier	33%	N/A	P Q:22 /21Days
NEUPOGEN INJECTION 300MCG/0.5ML 0.5ML SYR	4	Specialty Tier	33%	N/A	P Q:7 /21Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NEUPOGEN INJECTION 480MCG/0.8ML 10 X 0.8ML SYR	4	Specialty Tier	33%	N/A	P Q:11 /21Days
NEURONTIN 250MG/5ML TUBEX	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NEVANAC 0.1% DROPTAINER	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	Q:3 /30Days
NEXAVAR TABLETS 200MG 120 BOT	4	Specialty Tier	33%	N/A	P Q:120 /30Days
NEXIUM 10MG PACKET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:30 /30Days
NEXIUM 20MG CAPSULE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:30 /30Days
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:30 /30Days
NEXIUM 40MG CAPSULE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:30 /30Days
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:30 /30Days
NEXIUM IV 20MG VIAL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	P
NEXIUM IV 40MG VIAL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	P
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NEXT CHOICE 0.75 MG TABLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NIACOR 500MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NIASPAN 1000MG TABLET (90 CT)	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:60 /30Days
NIASPAN ER 500MG TABLET (90 CT)	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:90 /30Days
NIASPAN ER 750MG TABLET (90 CT)	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	Q:60 /30Days
NICARDIPINE HYDROCHLORIDE CAPSULES	1	Generic and Preferred Brand	$0.00	N/A	None
NICARDIPINE HYDROCHLORIDE CAPSULES 30MG 500 BOT	1	Generic and Preferred Brand	$0.00	N/A	None
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	Q:2688 /365Days
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	Q:360 /365Days
NIFEDIAC CC 30MG TABLET SA	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
NIFEDIAC CC 60MG TABLET SA	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NIFEDIAC CC 90MG TABLET SA	1	Generic and Preferred Brand	$0.00	N/A	S
NIFEDICAL XL 30MG TABLET SR OSMOTIC PUSH 24HR	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
NIFEDICAL XL 60MG TABLET SR OSMOTIC PUSH 24HR	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
NIFEDIPINE TABLETS EXTENDED RELEASE	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
NIFEDIPINE TABLETS EXTENDED RELEASE	1	Generic and Preferred Brand	$0.00	N/A	S Q:30 /30Days
NIFEDIPINE TABLETS EXTENDED RELEASE	1	Generic and Preferred Brand	$0.00	N/A	S
NILANDRON 150MG TABLET	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NIMODIPINE 30MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
NITRO BID OINTMENT 2% 1 GRAM X 48 PKG	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NITRO-DUR 0.3MG/HR PATCH	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NITRO-DUR 0.8MG/HR PATCH INST.	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NITROFURANTOIN 100MG CAPSULE (100 CT)	1	Generic and Preferred Brand	$0.00	N/A	None
NITROFURANTOIN MCR 50MG CAP	1	Generic and Preferred Brand	$0.00	N/A	None
NITROGLYCERIN .2MG/HR PATCH	1	Generic and Preferred Brand	$0.00	N/A	None
NITROGLYCERIN .4MG/HR PATCH	1	Generic and Preferred Brand	$0.00	N/A	None
NITROGLYCERIN .6MG/HR PATCH	1	Generic and Preferred Brand	$0.00	N/A	None
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX	1	Generic and Preferred Brand	$0.00	N/A	None
NITROSTAT 0.3MG TABLET SL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NITROSTAT 0.4MG TABLET SL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NITROSTAT 0.6MG TABLET SL	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NIZATIDINE 150MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
NIZATIDINE 300MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NORA-BE 0.35MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NORDITROPIN NORDIFLEX 10MG/1.5	4	Specialty Tier	33%	N/A	P Q:14 /28Days
NORDITROPIN NORDIFLEX INJECTION	4	Specialty Tier	33%	N/A	P Q:14 /28Days
NORDITROPIN NORDIFLEX INJECTION	4	Specialty Tier	33%	N/A	P Q:12 /28Days
NORDITROPIN NORDIFLEX INJECTION	4	Specialty Tier	33%	N/A	P Q:39 /28Days
NORETHINDRONE 5MG TABLET	1	Generic and Preferred Brand	$0.00	N/A	None
NORMOSOL -R INJ /D5W	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NORMOSOL-M AND DEXTROSE 5%	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NORMOSOL-R PH 7.4 IV SOLUTION	3	Non-Preferred Generic/ Non-Preferred Brand	$65.00	N/A	None
NORPACE CR 100MG CAPSULE SA	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NORPACE CR 150MG CAPSULE SA	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NORTREL 0.5-0.035 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NORTREL 1-0.035MG TABLET 21DAY	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NORTREL 1-0.035MG TABLET 28DAY	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NORTREL 7 DAYS X 3 TABLET	1	Generic and Preferred Brand	$0.00	N/A	Q:28 /28Days
NORTRIPTYLINE 10MG/5ML SOL	1	Generic and Preferred Brand	$0.00	N/A	None
NORTRIPTYLINE HCL 10MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
NORTRIPTYLINE HCL 25MG CAP	1	Generic and Preferred Brand	$0.00	N/A	None
NORTRIPTYLINE HCL 50MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
NORTRIPTYLINE HCL 75MG CAPSULE	1	Generic and Preferred Brand	$0.00	N/A	None
NORVIR 100 MG TABLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NORVIR 100MG SOFTGEL CAP	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NORVIR 80MG/ML ORAL SOLUTION	4	Specialty Tier	33%	N/A	None
NOVAMINE 15% 500ML IV	1	Generic and Preferred Brand	$0.00	N/A	P
NOVOLIN 70/30 100U/ML VIAL	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLIN 70/INJ 30 INNLT	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLIN N 100U/ML VIAL	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLIN N INJ INNOLET	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLIN R 100U/ML VIAL	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLOG 100U/ML VIAL	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLOG FLEXPEN SYRINGE	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NOVOLOG MIX 70/30 VIAL	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NOXAFIL 200MG/5ML SUSPENSION ORAL	4	Specialty Tier	33%	N/A	P Q:600 /30Days
NULYTELY WITH FLAVOR PACKS POWDER FOR SOLUTION 420;1.48;MG;MG;GM; 4 L BOT	2	Non-Preferred Generic/Preferred Brand	$35.00	N/A	None
NUTROPIN AQ 20MG/2ML PEN CART SOMATROPIN	4	Specialty Tier	33%	N/A	P Q:12 /28Days
NUTROPIN AQ INJ 10MG/2ML	4	Specialty Tier	33%	N/A	P Q:22 /28Days
NUTROPIN AQ NUSPIN SOLUTION	4	Specialty Tier	33%	N/A	P Q:44 /28Days
NUTROPIN AQ PEN CARTRIDGE 10MG/2 ML	4	Specialty Tier	33%	N/A	P Q:22 /28Days
NUTROPIN FOR INJECTION	4	Specialty Tier	33%	N/A	P Q:6 /28Days
NUTROPIN SOMATROPIN RDNAORIGIN FOR INJECTION 5MG 1 VIAL	4	Specialty Tier	33%	N/A	P Q:6 /28Days
NYAMYC 100000 U/G POWDER	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN 100000 UNT/ML ORAL SUSPENSION	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN 100000U/G POWDER	1	Generic and Preferred Brand	$0.00	N/A	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NYSTATIN 100000U/GM CREAM	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN OINTMENT 100000UNT/GM 15 GM TUBE	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN TABLET 500000U (100 CT)	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN/TRIAMCINOLONE CRM	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTATIN/TRIAMCINOLONE OINT 10000UNT/1MG	1	Generic and Preferred Brand	$0.00	N/A	None
NYSTOP 100000U/GM POWDER	1	Generic and Preferred Brand	$0.00	N/A	None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D Community CCRx Choice (PDP) Plan Formulary.

Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).
Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.
Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.
Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
- Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.
- No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.
Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
- Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
- Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
- Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $(2840)) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, on the 2011 Humana Walmart-Preferred Rx Plan the pricing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
- Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
- None - This drug does not fall under any drug utilization management controls.
- P - Prior Authorization -This drug is subject to prior authorization.
- S - Step Therapy -This drug is subject to step therapy.
- Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.

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

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