2012 Medicare Part D Plan Formulary Information |
CCM Direct Total Plan (HMO SNP) (H5989-008-0)
Benefit Details
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The CCM Direct Total Plan (HMO SNP) (H5989-008-0) Formulary Drugs Starting with the Letter S in NASSAU County, NY: CMS MA Region 3 which includes: NY
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in NY cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:6 /90Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in NY cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P |
SANDIMMUNE 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in NY cover SANDIMMUNE 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SAPHRIS 10mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in NY cover SAPHRIS 10mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SAPHRIS 5mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in NY cover SAPHRIS 5mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in NY cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in NY cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in NY cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in NY cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in NY cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Selegiline Hydrochloride 5mg/1 60 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NY cover Selegiline Hydrochloride 5mg/1 60 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in NY cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SEROMYCIN 250mg/250mg 40 CAPSULE in 1 BOTTLE / 250 mg in 1 CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SEROMYCIN 250mg/250mg 40 CAPSULE in 1 BOTTLE / 250 mg in 1 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:270 /90Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:270 /90Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:270 /90Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:270 /90Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:270 /90Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in NY cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:180 /90Days |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in NY cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:180 /90Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:180 /90Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in NY cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:270 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in NY cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in NY cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in NY cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in NY cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Simvastatin 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Simvastatin 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:90 /90Days |
SIMVASTATIN 20MG TABLET 10000 BOT ![Compare how all Medicare Part D PDP plans in NY cover SIMVASTATIN 20MG TABLET 10000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:90 /90Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in NY cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:90 /90Days |
Simvastatin 5mg/1 ![Compare how all Medicare Part D PDP plans in NY cover Simvastatin 5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:90 /90Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in NY cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:90 /90Days |
SINGULAIR 10MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SINGULAIR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in NY cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:90 /90Days |
SINGULAIR 4MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in NY cover SINGULAIR 4MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:90 /90Days |
SINGULAIR 5MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in NY cover SINGULAIR 5MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:90 /90Days |
SOD POLY SUL SUS 15GM/60 ![Compare how all Medicare Part D PDP plans in NY cover SOD POLY SUL SUS 15GM/60.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SODIUM BICARB INJ 7.5% ![Compare how all Medicare Part D PDP plans in NY cover SODIUM BICARB INJ 7.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SODIUM BICARB INJ 8.4% ![Compare how all Medicare Part D PDP plans in NY cover SODIUM BICARB INJ 8.4%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in NY cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Sodium Chloride 3g/100mL ![Compare how all Medicare Part D PDP plans in NY cover Sodium Chloride 3g/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NY cover Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in NY cover Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in NY cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SODIUM EDECRIN FOR INJECTION 50MG 1 X 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in NY cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in NY cover SOLIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOLU CORTEF INJECTION ![Compare how all Medicare Part D PDP plans in NY cover SOLU CORTEF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLU CORTEF INJECTION 100 MG/VIAL ![Compare how all Medicare Part D PDP plans in NY cover SOLU CORTEF INJECTION 100 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLU MEDROL FOR INJECTION 40 MG/ML ![Compare how all Medicare Part D PDP plans in NY cover SOLU MEDROL FOR INJECTION 40 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLU MEDROL FOR INJECTION 500 MG/ML ![Compare how all Medicare Part D PDP plans in NY cover SOLU MEDROL FOR INJECTION 500 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Solu-Medrol 125mg/mL 25 VIAL, PATENT DELIVERY SYSTEM in 1 PACKAGE / 2 mL in 1 VIAL, PATENT DELIVERY ![Compare how all Medicare Part D PDP plans in NY cover Solu-Medrol 125mg/mL 25 VIAL, PATENT DELIVERY SYSTEM in 1 PACKAGE / 2 mL in 1 VIAL, PATENT DELIVERY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLU-MEDROL 2000MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SOLU-MEDROL 2000MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P Q:90 /90Days |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P Q:90 /90Days |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in NY cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in NY cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in NY cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in NY cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in NY cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in NY cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTALOL HCL 120MG TABLET 100 BOT ![Compare how all Medicare Part D PDP plans in NY cover SOTALOL HCL 120MG TABLET 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTALOL HCL 160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SOTALOL HCL 160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTALOL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SOTALOL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in NY cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTRET 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SOTRET 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTRET 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SOTRET 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTRET 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SOTRET 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SOTRET 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SOTRET 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in NY cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:90 /90Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in NY cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in NY cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in NY cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SSD Cream 10g/1000g 85 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NY cover SSD Cream 10g/1000g 85 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in NY cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in NY cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in NY cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in NY cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in NY cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
STAVUDINE SOL 1MG/ML ![Compare how all Medicare Part D PDP plans in NY cover STAVUDINE SOL 1MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Stimate 1.5mg/mL 1 BOTTLE, SPRAY in 1 CARTON / 2.5 mL in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in NY cover Stimate 1.5mg/mL 1 BOTTLE, SPRAY in 1 CARTON / 2.5 mL in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in NY cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Suboxone 2; 0.5mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in NY cover Suboxone 2; 0.5mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Suboxone 8; 2mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in NY cover Suboxone 8; 2mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in NY cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in NY cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in NY cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in NY cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in NY cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFAMYLON 50G PACKET ![Compare how all Medicare Part D PDP plans in NY cover SULFAMYLON 50G PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFAMYLON CREAM 85GM 4 OZ TUBE ![Compare how all Medicare Part D PDP plans in NY cover SULFAMYLON CREAM 85GM 4 OZ TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in NY cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SUMATRIPTAN ![Compare how all Medicare Part D PDP plans in NY cover SUMATRIPTAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:12 /90Days |
Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in NY cover Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:12 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in NY cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:27 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in NY cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:54 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in NY cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:54 /90Days |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in NY cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:31 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in NY cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:31 /90Days |
SYNTHROID 100MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 100MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 125MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Synthroid 137ug/1 90 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Synthroid 137ug/1 90 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 150MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 150MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 175MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 175MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 200MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 200MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 25MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 300MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 300MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 50MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 75MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 75MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in NY cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |