2012 Medicare Part D Plan Formulary Information |
AlohaCare Advantage (HMO) (H5969-001-0)
Benefit Details
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The AlohaCare Advantage (HMO) (H5969-001-0) Formulary Drugs Starting with the Letter C in Kalawao County, HI: CMS MA Region 25 which includes: HI
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Caduet 10; 10mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Caduet 10; 10mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
Caduet 10; 20mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Caduet 10; 20mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 10MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 10MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 10MG/80MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 10MG/80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 2.5MG/10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 2.5MG/10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 2.5MG/20MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 2.5MG/20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 2.5MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 2.5MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 5MG/10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 5MG/10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 5MG/20MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 5MG/20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CADUET 5MG/40MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 5MG/40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
CADUET 5MG/80MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CADUET 5MG/80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
Calcipotriene 50ug/g 60 g in 1 CARTON ![Compare how all Medicare Part D PDP plans in HI cover Calcipotriene 50ug/g 60 g in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CALCIPOTRIENE TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CALCIPOTRIENE TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in HI cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CALCITRIOL 0.25MCG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 0.25MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CALCITRIOL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CALCITRIOL INJ 1MCG/ML ![Compare how all Medicare Part D PDP plans in HI cover CALCITRIOL INJ 1MCG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Calcium Acetate 667mg/1 200 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Calcium Acetate 667mg/1 200 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CALCIUM ACETATE CAPSULE 667 MG ![Compare how all Medicare Part D PDP plans in HI cover CALCIUM ACETATE CAPSULE 667 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAMILA 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAMILA 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CAMPATH INJECTION 30 MG/ML ![Compare how all Medicare Part D PDP plans in HI cover CAMPATH INJECTION 30 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | P |
CAMPRAL 333MG DOSE PAK ![Compare how all Medicare Part D PDP plans in HI cover CAMPRAL 333MG DOSE PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:180 /30Days |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in HI cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CANTIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CANTIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION in 1 CARTON ![Compare how all Medicare Part D PDP plans in HI cover CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CAPEX SHA 0.01% ![Compare how all Medicare Part D PDP plans in HI cover CAPEX SHA 0.01%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CAPRELSA 100mg/1 30 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover CAPRELSA 100mg/1 30 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | None |
CAPRELSA 300mg/1 30 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover CAPRELSA 300mg/1 30 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Captopril and Hydrochlorothiazide 25; 15mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Captopril and Hydrochlorothiazide 25; 15mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Captopril and Hydrochlorothiazide 25; 25mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Captopril and Hydrochlorothiazide 25; 25mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Captopril and Hydrochlorothiazide 50; 15mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Captopril and Hydrochlorothiazide 50; 15mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Captopril and Hydrochlorothiazide 50; 25mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Captopril and Hydrochlorothiazide 50; 25mg/1; mg/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARAC CRE 0.5% ![Compare how all Medicare Part D PDP plans in HI cover CARAC CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in HI cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
Carbamazepine 100mg/1 100 TABLET, CHEWABLE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbamazepine 100mg/1 100 TABLET, CHEWABLE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carbamazepine 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbamazepine 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carbamazepine 200mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbamazepine 200mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carbamazepine 300mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbamazepine 300mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE EXTENDED RELEASE TABLETS 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBAMAZEPINE ORAL SUSPENSION 100 MG/5ML ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE ORAL SUSPENSION 100 MG/5ML .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carbatrol 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbatrol 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CARBATROL 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARBATROL 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CARBATROL 300MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARBATROL 300MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carbidopa and Levodopa 25; 100mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED ![Compare how all Medicare Part D PDP plans in HI cover Carbidopa and Levodopa 25; 100mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carbidopa and Levodopa 50; 200mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED ![Compare how all Medicare Part D PDP plans in HI cover Carbidopa and Levodopa 50; 200mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA AND LEVODOPA ORALLY DISINTEGRATING TABLETS 25;250MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carbinoxamine Maleate 4mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbinoxamine Maleate 4mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Carbinoxamine Maleate 4mg/5mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carbinoxamine Maleate 4mg/5mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Carboplatin 10mg/mL ![Compare how all Medicare Part D PDP plans in HI cover Carboplatin 10mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CARDURA XL 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARDURA XL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARDURA XL 8MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CARDURA XL 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:60 /30Days |
CARIMUNE NF 3GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CARIMUNE NF 3GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CARISOPRODOL AND ASPIRIN TABLETS USP 325;200MG;MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL AND ASPIRIN TABLETS USP 325;200MG;MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE TABLETS USP 325;200;16MG;MG;MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE TABLETS USP 325;200;16MG;MG;MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARISOPRODOL TABLET USP 350MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CARISOPRODOL TABLET USP 350MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARNITOR 1GM/5ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CARNITOR 1GM/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CARTIA XT 300MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in HI cover CARTIA XT 300MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carvedilol 12.5mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Carvedilol 12.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carvedilol 25mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Carvedilol 25mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carvedilol 3.125mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Carvedilol 3.125mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Carvedilol 6.25mg/1 500 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Carvedilol 6.25mg/1 500 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CASODEX 50mg/1 30 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover CASODEX 50mg/1 30 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CEDAX 400mg/1 ![Compare how all Medicare Part D PDP plans in HI cover CEDAX 400mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CEENU 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CEENU 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CEENU 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEENU 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CEFACLOR CAPSULES ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFACLOR CAPSULES ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR ER 500MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in HI cover CEFACLOR ER 500MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cefadroxil 500mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Cefadroxil 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cefadroxil 500mg/5mL ![Compare how all Medicare Part D PDP plans in HI cover Cefadroxil 500mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFADROXIL FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in HI cover Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cefazolin 1g/1 ![Compare how all Medicare Part D PDP plans in HI cover Cefazolin 1g/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFAZOLIN 1GM/D5W BAG ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN 1GM/D5W BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFAZOLIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFAZOLIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFEPIME HCL 2 GRAM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFEPIME HCL 2 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFEPIME INJ 1GM 20ML APX 10x1G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFOTAXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 1GM 50 BOX VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFOTAXIME FOR INJECTION 2GM 25 VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 2GM 25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFOTAXIME FOR INJECTION 500MG 10 VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFOTAXIME FOR INJECTION 500MG 10 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFOTETAN 10 GM SOLR ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 10 GM SOLR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFOTETAN 1GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 1GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CEFOTETAN 2GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in HI cover CEFOTETAN 2GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
Cefoxitin 1g/1 10 POWDER in 1 CARTON ![Compare how all Medicare Part D PDP plans in HI cover Cefoxitin 1g/1 10 POWDER in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cefoxitin 2g/1 10 POWDER in 1 CARTON ![Compare how all Medicare Part D PDP plans in HI cover Cefoxitin 2g/1 10 POWDER in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFOXITIN FOR INJECTION SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CEFOXITIN FOR INJECTION SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cefpodoxime Proxetil 100mg/5mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cefpodoxime Proxetil 100mg/5mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cefpodoxime Proxetil 50mg/5mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cefpodoxime Proxetil 50mg/5mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFPODOXIME TAB 200MG ![Compare how all Medicare Part D PDP plans in HI cover CEFPODOXIME TAB 200MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFPROZIL 125mg/5mL ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL 125mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cefprozil 250mg/1 100 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cefprozil 250mg/1 100 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFPROZIL TABLETS 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CEFPROZIL TABLETS 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Ceftazidime and Dextrose 1g/50mL 24 CONTAINER in 1 CASE / 50 mL in 1 CONTAINER ![Compare how all Medicare Part D PDP plans in HI cover Ceftazidime and Dextrose 1g/50mL 24 CONTAINER in 1 CASE / 50 mL in 1 CONTAINER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Ceftazidime and Dextrose 2g/50mL 24 CONTAINER in 1 CASE / 50 mL in 1 CONTAINER ![Compare how all Medicare Part D PDP plans in HI cover Ceftazidime and Dextrose 2g/50mL 24 CONTAINER in 1 CASE / 50 mL in 1 CONTAINER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CEFTRIAXONE 10GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFTRIAXONE FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFTRIAXONE FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL ![Compare how all Medicare Part D PDP plans in HI cover CEFTRIAXONE FOR INJECTION 250MG BOX OF 10 VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Ceftriaxone Sodium 500mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Ceftriaxone Sodium 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFUROXIME 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME AXETIL 125MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFUROXIME AXETIL 500MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME AXETIL 500MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CEFUROXIME FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CELEBREX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CELEBREX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | Q:60 /30Days |
CELEBREX 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CELEBREX 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | Q:60 /30Days |
CELEBREX 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CELEBREX 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | Q:60 /30Days |
CELEBREX 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CELEBREX 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | Q:60 /30Days |
CELESTONE 0.6MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in HI cover CELESTONE 0.6MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CELLCEPT 200MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT 200MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CELLCEPT 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CELLCEPT CAPSULES 250MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT CAPSULES 250MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CELLCEPT IV INJ 500MG ![Compare how all Medicare Part D PDP plans in HI cover CELLCEPT IV INJ 500MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CELONTIN 300MG KAPSEAL ![Compare how all Medicare Part D PDP plans in HI cover CELONTIN 300MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CENESTIN 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CENESTIN 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CENESTIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CENESTIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CENESTIN 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CENESTIN 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CENESTIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CENESTIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CENESTIN 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CENESTIN 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
Cephalexin 125mg/5mL 200 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cephalexin 125mg/5mL 200 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEPHALEXIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEPHALEXIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEPHALEXIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEPHALEXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CEPHALEXIN CAPSULES 500MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CEPHALEXIN CAPSULES 500MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEREDASE 80UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CEREDASE 80UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | P |
CEREZYME INJ 200UNIT ![Compare how all Medicare Part D PDP plans in HI cover CEREZYME INJ 200UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | P |
CESAMET CAPSULES ![Compare how all Medicare Part D PDP plans in HI cover CESAMET CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CESIA 7 DAYS X 3 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CESIA 7 DAYS X 3 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CETIRIZINE HCL 5MG/5ML ![Compare how all Medicare Part D PDP plans in HI cover CETIRIZINE HCL 5MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHANTIX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CHANTIX 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CHANTIX STARTING MONTH PAK ![Compare how all Medicare Part D PDP plans in HI cover CHANTIX STARTING MONTH PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CHEMET 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CHEMET 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CHLORAMPHEN NA SUCC 1GM VL ![Compare how all Medicare Part D PDP plans in HI cover CHLORAMPHEN NA SUCC 1GM VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORDIAZEPOXIDE AND AMITRIPTYLINE HCL TABLET 12.5-5MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in HI cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLOROQUINE PH 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROQUINE PH 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLOROQUINE PHOSPHATE 250MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLOROTHIAZIDE 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROTHIAZIDE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLOROTHIAZIDE 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLOROTHIAZIDE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLOROTHIAZIDE SODIUM FOR INJECTION 500MG/VIAL ![Compare how all Medicare Part D PDP plans in HI cover CHLOROTHIAZIDE SODIUM FOR INJECTION 500MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | P |
CHLORPROMAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORPROMAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORPROMAZINE 25MG/ML AMP ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 25MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORPROMAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORPROMAZINE HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROMAZINE HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Chlorpromazine Hydrochloride 100mg/1 1000 TABLET, SUGAR COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Chlorpromazine Hydrochloride 100mg/1 1000 TABLET, SUGAR COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORPROPAMIDE 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORPROPAMIDE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Chlorpropamide 250mg/1 1000 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Chlorpropamide 250mg/1 1000 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORTHALIDONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORTHALIDONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORTHALIDONE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CHLORTHALIDONE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHLORZOXAZONE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CHLORZOXAZONE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Ciclopirox 7.7mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Ciclopirox 7.7mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CICLOPIROX GEL ![Compare how all Medicare Part D PDP plans in HI cover CICLOPIROX GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Ciclopirox Olamine 7.7mg/g 1 TUBE in 1 TUBE / 15 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover Ciclopirox Olamine 7.7mg/g 1 TUBE in 1 TUBE / 15 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CILOSTAZOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CILOSTAZOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CIMETIDINE 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cimetidine 200mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Cimetidine 200mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cimetidine 400mg/1 100 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cimetidine 400mg/1 100 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cimetidine 800mg/1 100 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cimetidine 800mg/1 100 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CIMETIDINE TABLETS ![Compare how all Medicare Part D PDP plans in HI cover CIMETIDINE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cipro 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in HI cover Cipro 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Cipro 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in HI cover Cipro 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPRO HC OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CIPRO HC OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CIPROFLOXACIN 0.3% EYE DROP ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 0.3% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CIPROFLOXACIN 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Ciprofloxacin 400mg/40mL 1 VIAL in 1 CARTON / 40 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in HI cover Ciprofloxacin 400mg/40mL 1 VIAL in 1 CARTON / 40 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CIPROFLOXACIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Ciprofloxacin ER 212.6; 287.5mg/1; mg/1 50 TABLET, FILM COATED, in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Ciprofloxacin ER 212.6; 287.5mg/1; mg/1 50 TABLET, FILM COATED, in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Ciprofloxacin ER 425.2; 574.9mg/1; mg/1 50 TABLET, FILM COATED, in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Ciprofloxacin ER 425.2; 574.9mg/1; mg/1 50 TABLET, FILM COATED, in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CIPROFLOXACIN HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CIPROFLOXACIN TABLETS 750MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CIPROFLOXACIN TABLETS 750MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cisplatin 100mg/100mL 1 VIAL in 1 CARTON / 100 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in HI cover Cisplatin 100mg/100mL 1 VIAL in 1 CARTON / 100 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CITALOPRAM HBR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HBR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HBR ORAL SOLUTION 10MG 240ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in HI cover CITALOPRAM HYDROBROMIDE TABLETS 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CITOLOPRAM HBR 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CITOLOPRAM HBR 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLADRIBINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLADRIBINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLAFORAN INJECTION ADD VANTAGE SYSTEM 1GM 25 X 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLARAVIS 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLARAVIS 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Claravis 30mg/1 3 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI cover Claravis 30mg/1 3 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLARAVIS 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLARAVIS 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Clarinex 0.5mg/mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Clarinex 0.5mg/mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARINEX 2.5MG REDITABS ![Compare how all Medicare Part D PDP plans in HI cover CLARINEX 2.5MG REDITABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | S |
CLARINEX 5MG REDITABS ![Compare how all Medicare Part D PDP plans in HI cover CLARINEX 5MG REDITABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | S |
CLARINEX 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARINEX 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | S |
CLARINEX-D 12 HOUR TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARINEX-D 12 HOUR TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLARINEX-D 24 HOUR 5; 240mg/1; mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover CLARINEX-D 24 HOUR 5; 240mg/1; mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLARITHROMYCIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLARITHROMYCIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLARITHROMYCIN ER 500MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN ER 500MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLARITHROMYCIN FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover CLARITHROMYCIN FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLEMASTINE FUM 2.68MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLEMASTINE FUM 2.68MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLEMASTINE FUMARATE SYRUP ![Compare how all Medicare Part D PDP plans in HI cover CLEMASTINE FUMARATE SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLEOCIN 300MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 300MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLEOCIN 600MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 600MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLEOCIN 900MG/D5W/GALAXY ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN 900MG/D5W/GALAXY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLEOCIN HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLEOCIN PED SOL 75MG/5ML ![Compare how all Medicare Part D PDP plans in HI cover CLEOCIN PED SOL 75MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLINDAMYCIN 150MG/ML ADDVAN ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN 150MG/ML ADDVAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLINDAMYCIN HCL 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN HCL 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLINDAMYCIN HYDROCHLORIDE CAPSULES ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN HYDROCHLORIDE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLINDAMYCIN PHOSP 1% LOTION ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSP 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
clindamycin phosphate 10mg/mL 1 BOTTLE in 1 CARTON / 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover clindamycin phosphate 10mg/mL 1 BOTTLE in 1 CARTON / 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clindamycin Phosphate and Benzoyl Peroxide 1 KIT ![Compare how all Medicare Part D PDP plans in HI cover Clindamycin Phosphate and Benzoyl Peroxide 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in HI cover CLINDAMYCIN PHOSPHATE VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLINIMIX 2.75%/5% INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 2.75%/5% INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX 4.25/10 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX 4.25/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLINIMIX 5/15 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/15 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX E 2.75/10 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 2.75/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CLINIMIX E 4.25/25 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 4.25/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX E 5/25 SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLINIMIX E 5%/15% INJECTION 2000ML BAG ![Compare how all Medicare Part D PDP plans in HI cover CLINIMIX E 5%/15% INJECTION 2000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOBETASOL 0.05% SHAMPOO ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL 0.05% SHAMPOO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOBETASOL 0.05% TOPICAL LOTION ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL 0.05% TOPICAL LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clobetasol Propionate 0.5mg/g 1 CAN in 1 CARTON / 100 g in 1 CAN ![Compare how all Medicare Part D PDP plans in HI cover Clobetasol Propionate 0.5mg/g 1 CAN in 1 CARTON / 100 g in 1 CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Clobetasol Propionate 0.5mg/mL 50 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Clobetasol Propionate 0.5mg/mL 50 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOLAR 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CLOLAR 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | P |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Clonidine 0.1mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in HI cover Clonidine 0.1mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Clonidine 0.2mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in HI cover Clonidine 0.2mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Clonidine 0.3mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in HI cover Clonidine 0.3mg/d 4 POUCH in 1 CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOPIDOGREL 300 MG tablet ![Compare how all Medicare Part D PDP plans in HI cover CLOPIDOGREL 300 MG tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLOPIDOGREL TAB 75MG ![Compare how all Medicare Part D PDP plans in HI cover CLOPIDOGREL TAB 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | Q:30 /30Days |
CLORPRES 0.1-15 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLORPRES 0.1-15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLORPRES 0.2-15 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLORPRES 0.2-15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLORPRES 0.3-15 TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLORPRES 0.3-15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE SOLUTION TOPICAL 1% 30ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE-BETAMETHASONE 1-0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CLOZAPINE 100mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 100mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOZAPINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CLOZARIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLOZARIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CLOZARIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CLOZARIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CODEINE SULFATE 30 MG TABLET 3100 ![Compare how all Medicare Part D PDP plans in HI cover CODEINE SULFATE 30 MG TABLET 3100.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Codeine sulfate 60mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Codeine sulfate 60mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CODEINE SULFATE TABLETS ![Compare how all Medicare Part D PDP plans in HI cover CODEINE SULFATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Colcrys 0.6mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Colcrys 0.6mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in HI cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
COLESTIPOL HYDROCHLORIDE 5g/1 100 SUSPENSION in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover COLESTIPOL HYDROCHLORIDE 5g/1 100 SUSPENSION in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
colistimethate 150mg/2mL 1 VIAL in 1 CARTON / 2 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in HI cover colistimethate 150mg/2mL 1 VIAL in 1 CARTON / 2 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
COLY MYCIN S OTIC SUSPENSION 3;3.3;10MG/ML;MG/ 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in HI cover COLY MYCIN S OTIC SUSPENSION 3;3.3;10MG/ML;MG/ 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
COMBIGAN 0.2%-0.5% DROPS ![Compare how all Medicare Part D PDP plans in HI cover COMBIGAN 0.2%-0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
COMBIVENT INHALER ![Compare how all Medicare Part D PDP plans in HI cover COMBIVENT INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
COMBIVIR 150; 300mg/1; mg/1 120 TABLET, FILM COATED in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in HI cover COMBIVIR 150; 300mg/1; mg/1 120 TABLET, FILM COATED in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | None |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in HI cover COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 33% | None |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in HI cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
COMTAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover COMTAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in HI cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CONCERTA 54mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover CONCERTA 54mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CONCERTA ER TABLETS 18MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in HI cover CONCERTA ER TABLETS 18MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CONCERTA ER TABLETS 27MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in HI cover CONCERTA ER TABLETS 27MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CONCERTA ER TABLETS 36MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in HI cover CONCERTA ER TABLETS 36MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CONSTULOSE 10GM/15ML SYRUP ![Compare how all Medicare Part D PDP plans in HI cover CONSTULOSE 10GM/15ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in HI cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
Cordran 0.5mg/g 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover Cordran 0.5mg/g 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Cordran 0.5mg/mL 60 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Cordran 0.5mg/mL 60 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CORDRAN TAPE 4MCG/SQCM 1 X 80 X 3 CTR ![Compare how all Medicare Part D PDP plans in HI cover CORDRAN TAPE 4MCG/SQCM 1 X 80 X 3 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in HI cover COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in HI cover COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in HI cover COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in HI cover COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CORTISONE ACETATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CORTISONE ACETATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CORTISPORIN CRE 0.5% ![Compare how all Medicare Part D PDP plans in HI cover CORTISPORIN CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CORTISPORIN TC OTIC SUSPENSION 3;3.3;0.5MG/ML; 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in HI cover CORTISPORIN TC OTIC SUSPENSION 3;3.3;0.5MG/ML; 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
Cortomycin 10; 3.5; 10000mg/mL; mg/mL; [USP'U]/mL 1 10 mL BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in HI cover Cortomycin 10; 3.5; 10000mg/mL; mg/mL; [USP'U]/mL 1 10 mL BOTTLE, DROPPER .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cortomycin 10; 3.5; 10000mg/mL; mg/mL; [USP'U]/mL 1 10 mL BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in HI cover Cortomycin 10; 3.5; 10000mg/mL; mg/mL; [USP'U]/mL 1 10 mL BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
COSMEGEN 0.5MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover COSMEGEN 0.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | P |
COZAAR 100mg/1 1000 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover COZAAR 100mg/1 1000 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:30 /30Days |
COZAAR 50mg/1 90 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover COZAAR 50mg/1 90 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COZAAR25MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover COZAAR25MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | Q:60 /30Days |
Creon 256.11mg/1 1 BOTTLE in 1 CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Creon 256.11mg/1 1 BOTTLE in 1 CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
Crinone 90mg/1.125g 15 APPLICATOR in 1 CARTON / 1.125 g in 1 APPLICATOR ![Compare how all Medicare Part D PDP plans in HI cover Crinone 90mg/1.125g 15 APPLICATOR in 1 CARTON / 1.125 g in 1 APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CRIXIVAN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CRIXIVAN 400mg/1 90 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover CRIXIVAN 400mg/1 90 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CROMOLYN NEBULIZER SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover CROMOLYN NEBULIZER SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | P |
CROMOLYN SODIUM 100 MG/5 ML ![Compare how all Medicare Part D PDP plans in HI cover CROMOLYN SODIUM 100 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
CUPRIMINE CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover CUPRIMINE CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Cutivate 0.5mg/mL 1 BOTTLE in 1 CARTON / 120 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cutivate 0.5mg/mL 1 BOTTLE in 1 CARTON / 120 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Cyclafem 1/35 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI cover Cyclafem 1/35 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
Cyclafem 7/7/7 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI cover Cyclafem 7/7/7 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CYCLOBENZAPRINE HCL 5MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYCLOBENZAPRINE HCL 5MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cyclobenzaprine Hydrochloride 15mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Cyclobenzaprine Hydrochloride 15mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Cyclobenzaprine Hydrochloride 30mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Cyclobenzaprine Hydrochloride 30mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
CYCLOBENZAPRINE HYROCHLORIDE 7.5mg/1 ![Compare how all Medicare Part D PDP plans in HI cover CYCLOBENZAPRINE HYROCHLORIDE 7.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOPHOSPHAMIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYCLOPHOSPHAMIDE 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover CYCLOPHOSPHAMIDE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
Cyclosporine 100mg/1 30 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI cover Cyclosporine 100mg/1 30 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
Cyclosporine 50mg/1 30 BLISTER PACK in 1 CARTON / 1 CAPSULE, LIQUID FILLED in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI cover Cyclosporine 50mg/1 30 BLISTER PACK in 1 CARTON / 1 CAPSULE, LIQUID FILLED in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |
Cyclosporine 50mg/mL 10 VIAL in 1 BOX / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in HI cover Cyclosporine 50mg/mL 10 VIAL in 1 BOX / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in HI cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYKLOKAPRON 100MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in HI cover CYKLOKAPRON 100MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CYMBALTA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYMBALTA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Cymbalta 60mg/1 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Cymbalta 60mg/1 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in HI cover CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CYPROHEPTADINE HCL 4 MG ![Compare how all Medicare Part D PDP plans in HI cover CYPROHEPTADINE HCL 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in HI cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in HI cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $80.00 | None |
CYTARABINE 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYTARABINE 500MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $14.00 | P |
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD ![Compare how all Medicare Part D PDP plans in HI cover CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$4.00 | $8.00 | P |
CYTOVENE IV INJECTION ![Compare how all Medicare Part D PDP plans in HI cover CYTOVENE IV INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$80.00 | $160.00 | P |