2012 Medicare Part D Plan Formulary Information |
Today's Options Premier Plus 250A (PFFS) (H5421-215-0)
Sanctioned Plan
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The Today's Options Premier Plus 250A (PFFS) (H5421-215-0) Formulary Drugs Starting with the Letter E in SAINTE GENEVIEVE County, MO: CMS MA Region 15 which includes: MO
|
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 |
E.E.S. GRAN SUS 200/5ML ![Compare how all Medicare Part D PDP plans in MO cover E.E.S. GRAN SUS 200/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
ECONAZOLE NITRATE 1% CREAM 85GM TUBE ![Compare how all Medicare Part D PDP plans in MO cover ECONAZOLE NITRATE 1% CREAM 85GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ED K+10 TABLET ![Compare how all Medicare Part D PDP plans in MO cover ED K+10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
EDECRIN 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover EDECRIN 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EDURANT 27.5mg/1 ![Compare how all Medicare Part D PDP plans in MO cover EDURANT 27.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:30 /30Days |
EES 400 TABLET 400MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover EES 400 TABLET 400MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Effient 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Effient 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
Effient 5mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Effient 5mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
ELIDEL 1% CREAM ![Compare how all Medicare Part D PDP plans in MO cover ELIDEL 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | S Q:60 /30Days |
Elitek 3 KIT in 1 CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in MO cover Elitek 3 KIT in 1 CARTON / 1 KIT in 1 KIT.](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 |
ELIXOPHYLLIN 80mg/15mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ELIXOPHYLLIN 80mg/15mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
Ella 30mg/1 1 BLISTER PACK in 1 CARTON / 1 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover Ella 30mg/1 1 BLISTER PACK in 1 CARTON / 1 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
ELMIRON 100mg/1 100 CAPSULE, GELATIN COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ELMIRON 100mg/1 100 CAPSULE, GELATIN COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EMCYT 140MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover EMCYT 140MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
EMEND CAPSULES 125MG 6 BLPK ![Compare how all Medicare Part D PDP plans in MO cover EMEND CAPSULES 125MG 6 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:6 /30Days |
EMEND CAPSULES 80MG 2 BLPK ![Compare how all Medicare Part D PDP plans in MO cover EMEND CAPSULES 80MG 2 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:6 /30Days |
EMEND TRIFOLD PACK ![Compare how all Medicare Part D PDP plans in MO cover EMEND TRIFOLD PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:6 /30Days |
Emoquette 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover Emoquette 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:28 /28Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H ![Compare how all Medicare Part D PDP plans in MO cover EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H ![Compare how all Medicare Part D PDP plans in MO cover EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H ![Compare how all Medicare Part D PDP plans in MO cover EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P Q:30 /30Days |
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 MO cover EMTRIVA 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EMTRIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover EMTRIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
ENABLEX 15MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENABLEX 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
Enablex 7.5mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Enablex 7.5mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
ENALAPRIL MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ENALAPRIL MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Enalapril Maleate 2.5mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Enalapril Maleate 2.5mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Enalapril Maleate 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Enalapril Maleate 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Enalapril Maleate 5mg/1 1000 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Enalapril Maleate 5mg/1 1000 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ENBREL 25 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MO 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:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENBREL 25MG KIT ![Compare how all Medicare Part D PDP plans in MO cover ENBREL 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:16 /28Days |
ENBREL 50mg/mL ![Compare how all Medicare Part D PDP plans in MO cover ENBREL 50mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:8 /28Days |
ENDOCET 10/650MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENDOCET 10/650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:180 /30Days |
ENDOCET 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENDOCET 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:360 /30Days |
ENDOCET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENDOCET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:360 /30Days |
ENDOCET 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENDOCET 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:360 /30Days |
ENDOCET 7.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENDOCET 7.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:240 /30Days |
ENDODAN TABLETS 325;4.8355MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover ENDODAN TABLETS 325;4.8355MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:360 /30Days |
ENGERIX B INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENGERIX B INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P |
ENGERIX B INJECTION 20MCG/ML ![Compare how all Medicare Part D PDP plans in MO cover ENGERIX B INJECTION 20MCG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P |
ENGERIX-B 10MCG 10 X 0.5ML VIALSD ![Compare how all Medicare Part D PDP plans in MO cover ENGERIX-B 10MCG 10 X 0.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENJUVIA 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENJUVIA 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:30 /30Days |
ENJUVIA 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENJUVIA 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:30 /30Days |
ENJUVIA 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENJUVIA 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:30 /30Days |
ENJUVIA 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENJUVIA 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P Q:30 /30Days |
ENJUVIA 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ENJUVIA 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | P |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:24 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:30 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:9 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:12 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:18 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:24 /30Days |
ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL ![Compare how all Medicare Part D PDP plans in MO cover ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Epinephrine 0.1mg/mL ![Compare how all Medicare Part D PDP plans in MO cover Epinephrine 0.1mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
EPIPEN 0.3MG AUTO-INJECTOR ![Compare how all Medicare Part D PDP plans in MO cover EPIPEN 0.3MG AUTO-INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:2 /30Days |
EPIPEN JR 0.15MG AUTO-INJCT ![Compare how all Medicare Part D PDP plans in MO cover EPIPEN JR 0.15MG AUTO-INJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:2 /30Days |
EPITOL 200MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EPITOL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
EPIVIR HBV 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EPIVIR HBV 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
EPIVIR HBV 25MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in MO cover EPIVIR HBV 25MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
EPIVIR ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover EPIVIR ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EPZICOM TABLETS ![Compare how all Medicare Part D PDP plans in MO cover EPZICOM TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EQUETRO CAPSULES 200MG 120 BOT ![Compare how all Medicare Part D PDP plans in MO cover EQUETRO CAPSULES 200MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EQUETRO CAPSULES 300MG 120 BOT ![Compare how all Medicare Part D PDP plans in MO cover EQUETRO CAPSULES 300MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
EQUETRO EXTENDED RELEASE CAPSULES 100MG 120 BOT ![Compare how all Medicare Part D PDP plans in MO cover EQUETRO EXTENDED RELEASE CAPSULES 100MG 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
ERAXIS 100mg/30mL 30 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in MO cover ERAXIS 100mg/30mL 30 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P |
ERGOMAR SUBLINGUAL TABLET 2MG ![Compare how all Medicare Part D PDP plans in MO cover ERGOMAR SUBLINGUAL TABLET 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
ERIVEDGE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover ERIVEDGE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
ERRIN 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ERRIN 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:28 /28Days |
ERY 2% PADS 2% 60 PADS JAR ![Compare how all Medicare Part D PDP plans in MO cover ERY 2% PADS 2% 60 PADS JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERY-TAB TAB 250MG EC ![Compare how all Medicare Part D PDP plans in MO cover ERY-TAB TAB 250MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERY-TAB TAB 333MG EC ![Compare how all Medicare Part D PDP plans in MO cover ERY-TAB TAB 333MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERYTHROCIN 500MG ADDVNT VL ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROCIN 500MG ADDVNT VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERYTHROCIN TAB 250MG ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROCIN TAB 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERYTHROMYCIN 2% SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROMYCIN 2% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Erythromycin 20mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Erythromycin 20mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERYTHROMYCIN 500 MG FILMTAB ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROMYCIN 500 MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERYTHROMYCIN ETHYLSUCCINATE AND SULFISOXAZOLE ACETYL POWDER FOR ORAL SUSPENSION 200;600MG/5ML;MG/ 10 ![Compare how all Medicare Part D PDP plans in MO 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 |
$4.00 | N/A | None |
ERYTHROMYCIN ETHYLSUCCINATE TABLETS 400 MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROMYCIN ETHYLSUCCINATE TABLETS 400 MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE ![Compare how all Medicare Part D PDP plans in MO 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 |
$4.00 | N/A | None |
ERYTHROMYCIN TAB 250MG BS ![Compare how all Medicare Part D PDP plans in MO cover ERYTHROMYCIN TAB 250MG BS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESCITALOPRAM 10 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESCITALOPRAM 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:45 /30Days |
ESCITALOPRAM 20 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESCITALOPRAM 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
ESCITALOPRAM 5 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESCITALOPRAM 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESCITALOPRAM OXALATE 5 MG/5 ML ![Compare how all Medicare Part D PDP plans in MO cover ESCITALOPRAM OXALATE 5 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:600 /30Days |
ESTRACE VAG CREAM 0.1MG/GM ![Compare how all Medicare Part D PDP plans in MO cover ESTRACE VAG CREAM 0.1MG/GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
ESTRADERM 0.05MG/24H PATCH TRANSDERMAL SEMIWEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADERM 0.05MG/24H PATCH TRANSDERMAL SEMIWEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:8 /28Days |
ESTRADERM 0.1MG/24HR PATCH TRANSDERMAL SEMIWEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADERM 0.1MG/24HR PATCH TRANSDERMAL SEMIWEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:8 /28Days |
ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.05MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL 0.05MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.1MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL 0.1MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESTRADIOL TABLET 1MG (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL TABLET 1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESTRADIOL VALERATE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ESTRADIOL VALERATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ESTROPIPATE 0.625 TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESTROPIPATE 0.625 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | P |
ESTROPIPATE 1.25 TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESTROPIPATE 1.25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | P |
ESTROPIPATE 2.5 TABLET ![Compare how all Medicare Part D PDP plans in MO cover ESTROPIPATE 2.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | P |
ETHAMBUTOL HCL 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ETHAMBUTOL HCL 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
Ethambutol Hydrochloride 100mg/1 ![Compare how all Medicare Part D PDP plans in MO cover Ethambutol Hydrochloride 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | 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 MO 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 |
$4.00 | N/A | Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 MO 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 |
$4.00 | N/A | Q:28 /28Days |
Ethosuximide 250mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Ethosuximide 250mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETHOSUXIMIDE 250MG/5ML SYRP ![Compare how all Medicare Part D PDP plans in MO cover ETHOSUXIMIDE 250MG/5ML SYRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETODOLAC 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETODOLAC 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETODOLAC 400MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 400MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETODOLAC 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
ETODOLAC 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
ETODOLAC 500mg/1 ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |
ETODOLAC 600MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in MO cover ETODOLAC 600MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | None |
Eurax Lotion and Cream 100mg/g 454 g in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Eurax Lotion and Cream 100mg/g 454 g in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Eurax Lotion and Cream 100mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Eurax Lotion and Cream 100mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | None |
Evista 60mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Evista 60mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
EXALGO 12mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover EXALGO 12mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:120 /30Days |
EXALGO 16mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover EXALGO 16mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:120 /30Days |
EXALGO 8mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover EXALGO 8mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:120 /30Days |
EXELON 2MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover EXELON 2MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:180 /30Days |
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in MO cover EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in MO cover EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | Q:30 /30Days |
Exemestane 25mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exemestane 25mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | S |
EXFORGE 10MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXFORGE 10MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
EXFORGE 10MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXFORGE 10MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXFORGE 5MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXFORGE 5MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
EXFORGE 5MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXFORGE 5MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exforge HCT 10; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exforge HCT 10; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 25; 320mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exforge HCT 10; 25; 320mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Exforge HCT 5; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exforge HCT 5; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
Exforge HCT 5; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Exforge HCT 5; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | N/A | Q:30 /30Days |
EXJADE 125MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXJADE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | N/A | P |
EXJADE 250MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXJADE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
EXJADE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover EXJADE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
EXTAVIA 15 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover EXTAVIA 15 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:15 /30Days |
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 MO cover EXTENDED PHENYTOIN SODIUM CAPSULES 300 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | N/A | None |