2012 Medicare Part D Plan Formulary Information |
WindsorSterling Gold Access Plan (PFFS) (H5006-017-17)
Benefit Details
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The WindsorSterling Gold Access Plan (PFFS) (H5006-017-17) Formulary Drugs Starting with the Letter F in SAINT FRANCOIS County, MO: CMS MA Region 15 which includes: MO
|
Drugs Starting with Letter F
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
FABRAZYME 35MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover FABRAZYME 35MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FACTIVE 320mg/1 7 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover FACTIVE 320mg/1 7 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$34.00 | $102.00 | Q:7 /21Days |
FAMCICLOVIR 125MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FAMCICLOVIR 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FAMCICLOVIR 250MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FAMCICLOVIR 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FAMCICLOVIR 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FAMCICLOVIR 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FAMOTIDINE 40MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FAMOTIDINE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FAMOTIDINE INJECTION 10MG 25 X 2ML VIALSD ![Compare how all Medicare Part D PDP plans in MO cover FAMOTIDINE INJECTION 10MG 25 X 2ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FANAPT 1 KIT in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 1 KIT in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 10mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 10mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 12mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 12mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FANAPT 1mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 1mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 2mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 2mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 4mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 4mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 6mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 6mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FANAPT 8mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FANAPT 8mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FARESTON 60MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FARESTON 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$34.00 | $102.00 | None |
FASLODEX INJECTION ![Compare how all Medicare Part D PDP plans in MO cover FASLODEX INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FazaClo 100mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FazaClo 100mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FazaClo 12.5mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FazaClo 12.5mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FazaClo 150mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FazaClo 150mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FazaClo 25mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FazaClo 25mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FAZACLO TABLETS ORALLY DISINTEGRATING ![Compare how all Medicare Part D PDP plans in MO cover FAZACLO TABLETS ORALLY DISINTEGRATING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBAMATE 400 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FELBAMATE 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBAMATE 600 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FELBAMATE 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBAMATE 600 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in MO cover FELBAMATE 600 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBATOL 400MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FELBATOL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBATOL 600MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FELBATOL 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELBATOL 600MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in MO cover FELBATOL 600MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FELODIPINE ER 2.5MG TABLET 90 TABLET BOT ![Compare how all Medicare Part D PDP plans in MO cover FELODIPINE ER 2.5MG TABLET 90 TABLET BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FELODIPINE TABLET ER 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover FELODIPINE TABLET ER 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FELODIPINE TABLET ER 5MG (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover FELODIPINE TABLET ER 5MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FEMHRT 0.5MG/2.5MCG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FEMHRT 0.5MG/2.5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FEMHRT 1/5 TABLET ![Compare how all Medicare Part D PDP plans in MO cover FEMHRT 1/5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | P |
FENOFIBRATE 134MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover FENOFIBRATE 134MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENOFIBRATE 160mg/1 90 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover FENOFIBRATE 160mg/1 90 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENOFIBRATE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover FENOFIBRATE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENOFIBRATE 54MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FENOFIBRATE 54MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENOFIBRATE 67MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover FENOFIBRATE 67MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENOPROFEN 600MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FENOPROFEN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | S Q:10 /30Days |
FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | S Q:10 /30Days |
FENTANYL 75 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL 75 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | S Q:10 /30Days |
FENTANYL CITRATE 1600ug/1 30 BLISTER PACK in 1 CARTON / 1 LOZENGE in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE 1600ug/1 30 BLISTER PACK in 1 CARTON / 1 LOZENGE in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
FENTANYL CITRATE OTFC 200 MCG ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL CITRATE OTFC 200 MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:120 /30Days |
FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | S Q:10 /30Days |
FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in MO cover FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | S Q:10 /30Days |
FINASTERIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FINASTERIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Firazyr 30.0mg/3mL 1 SYRINGE, GLASS in 1 CARTON / 3 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in MO cover Firazyr 30.0mg/3mL 1 SYRINGE, GLASS in 1 CARTON / 3 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FLECAINIDE ACETATE 100 MG TAB #60 EA ![Compare how all Medicare Part D PDP plans in MO cover FLECAINIDE ACETATE 100 MG TAB #60 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLECAINIDE ACETATE 150 MG TAB 360 EA ![Compare how all Medicare Part D PDP plans in MO cover FLECAINIDE ACETATE 150 MG TAB 360 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLECAINIDE ACETATE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover FLECAINIDE ACETATE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:60 /30Days |
FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:60 /30Days |
FLOVENT DISKUS POWDER 50MCG 60 CTR ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT DISKUS POWDER 50MCG 60 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:60 /30Days |
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:12 /30Days |
FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:12 /30Days |
FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in MO cover FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:11 /30Days |
Fluconazole 200mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Fluconazole 200mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
Fluconazole 50mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Fluconazole 50mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FLUCONAZOLE ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in MO cover FLUCONAZOLE ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUCONAZOLE ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in MO cover FLUCONAZOLE ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUCONAZOLE TABLETS ![Compare how all Medicare Part D PDP plans in MO cover FLUCONAZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FLUCONAZOLE TABLETS ![Compare how all Medicare Part D PDP plans in MO cover FLUCONAZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FLUDARABINE 50MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover FLUDARABINE 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL ![Compare how all Medicare Part D PDP plans in MO cover FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | Q:50 /30Days |
FLUOCINOLONE 0.01% BODY OIL ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINOLONE 0.01% BODY OIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FLUOCINOLONE 0.01% CREAM ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINOLONE 0.01% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOCINOLONE 0.01% SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINOLONE 0.01% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOCINOLONE 0.025% CREAM ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINOLONE 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOCINOLONE 0.025% OINTMENT ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINOLONE 0.025% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOCINONIDE 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover FLUOCINONIDE 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Fluocinonide 0.5mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Fluocinonide 0.5mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fluocinonide 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Fluocinonide 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOROMETHOLONE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in MO cover FLUOROMETHOLONE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOROURACIL 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in MO cover FLUOROURACIL 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOROURACIL 5% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in MO cover FLUOROURACIL 5% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fluorouracil 50mg/mL ![Compare how all Medicare Part D PDP plans in MO cover Fluorouracil 50mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUOROURACIL CREA 5% ![Compare how all Medicare Part D PDP plans in MO cover FLUOROURACIL CREA 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | Q:600 /30Days |
FLUOXETINE CAPSULES 10MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover FLUOXETINE CAPSULES 10MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | Q:240 /30Days |
Fluoxetine Hydrochloride 20mg/1 100 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Fluoxetine Hydrochloride 20mg/1 100 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | Q:120 /30Days |
FLUOXYMESTERONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUOXYMESTERONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUPHENAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUPHENAZINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FLUPHENAZINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUPHENAZINE 2.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 2.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUPHENAZINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUPHENAZINE 5MG/ML CONC ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE 5MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fluphenazine Decanoate 25mg/mL ![Compare how all Medicare Part D PDP plans in MO cover Fluphenazine Decanoate 25mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUPHENAZINE HCL 2.5MG/5ML ELIXIR ![Compare how all Medicare Part D PDP plans in MO cover FLUPHENAZINE HCL 2.5MG/5ML ELIXIR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLURBIPROFEN 0.03% EYE DROP ![Compare how all Medicare Part D PDP plans in MO cover FLURBIPROFEN 0.03% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Flurbiprofen 100mg/1 500 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Flurbiprofen 100mg/1 500 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLURBIPROFEN 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLURBIPROFEN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Flutamide 125mg/1 500 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Flutamide 125mg/1 500 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Fluticasone Propionate 0.05mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Fluticasone Propionate 0.05mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fluticasone Propionate 0.5mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Fluticasone Propionate 0.5mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in MO cover FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | Q:16 /30Days |
FLUVASTATIN SODIUM 20 MG CAP ![Compare how all Medicare Part D PDP plans in MO cover FLUVASTATIN SODIUM 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FLUVASTATIN SODIUM 40 MG CAP ![Compare how all Medicare Part D PDP plans in MO cover FLUVASTATIN SODIUM 40 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FLUVOXAMINE MALEATE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FLUVOXAMINE MALEATE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FLUVOXAMINE MALEATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover FLUVOXAMINE MALEATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:45 /30Days |
Fluvoxamine maleate 50mg/1 100 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Fluvoxamine maleate 50mg/1 100 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:45 /30Days |
FML FORTE 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in MO cover FML FORTE 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
FML S.O.P. 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in MO cover FML S.O.P. 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Fomepizole 1g/mL 1 VIAL in 1 CARTON / 1.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in MO cover Fomepizole 1g/mL 1 VIAL in 1 CARTON / 1.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FORADIL AEROLIZER 12 MCG CAP ![Compare how all Medicare Part D PDP plans in MO cover FORADIL AEROLIZER 12 MCG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | None |
Forteo 250ug/mL 1 SYRINGE in 1 CARTON / 2.4 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in MO cover Forteo 250ug/mL 1 SYRINGE in 1 CARTON / 2.4 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | P |
FOSINOPRIL SODIUM 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover FOSINOPRIL SODIUM 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FOSINOPRIL SODIUM 20MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FOSINOPRIL SODIUM 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FOSINOPRIL SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FOSINOPRIL SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
Fosphenytoin 50mg/mL ![Compare how all Medicare Part D PDP plans in MO cover Fosphenytoin 50mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | P |
FOSRENOL 1000MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover FOSRENOL 1000MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$34.00 | $102.00 | None |
FOSRENOL 500MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover FOSRENOL 500MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$34.00 | $102.00 | None |
FOSRENOL 750MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover FOSRENOL 750MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$34.00 | $102.00 | None |
Fragmin 12500[iU]/0.5mL ![Compare how all Medicare Part D PDP plans in MO cover Fragmin 12500[iU]/0.5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | Q:10 /10Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Fragmin 15000[iU]/0.6mL ![Compare how all Medicare Part D PDP plans in MO cover Fragmin 15000[iU]/0.6mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | Q:12 /10Days |
Fragmin 18000[iU]/0.72mL ![Compare how all Medicare Part D PDP plans in MO cover Fragmin 18000[iU]/0.72mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | Q:14 /10Days |
FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1 ![Compare how all Medicare Part D PDP plans in MO cover FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:8 /10Days |
FRAGMIN 2500UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in MO cover FRAGMIN 2500UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:4 /10Days |
FRAGMIN 5000UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in MO cover FRAGMIN 5000UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:4 /10Days |
FRAGMIN INJECTION 10000UNITS 1 X 10 SYR ![Compare how all Medicare Part D PDP plans in MO cover FRAGMIN INJECTION 10000UNITS 1 X 10 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | Q:20 /10Days |
FRAGMIN INJECTION 7500UNT/ML ![Compare how all Medicare Part D PDP plans in MO cover FRAGMIN INJECTION 7500UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | Q:6 /10Days |
Furosemide 10mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 4 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in MO cover Furosemide 10mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 4 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | P |
FUROSEMIDE 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover FUROSEMIDE 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FUROSEMIDE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MO cover FUROSEMIDE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FUROSEMIDE 40MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover FUROSEMIDE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FUROSEMIDE 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in MO cover FUROSEMIDE 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $45.00 | None |
FUROSEMIDE 80MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover FUROSEMIDE 80MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $15.00 | None |
FUSILEV I.V. 50 MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover FUSILEV I.V. 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $252.00 | P |
FUZEON CONVENIENCE KIT ![Compare how all Medicare Part D PDP plans in MO cover FUZEON CONVENIENCE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
30% | 30% | None |