2012 Medicare Part D Plan Formulary Information |
United American - Preferred (PDP) (S5755-028-0)
Benefit Details
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The United American - Preferred (PDP) (S5755-028-0) Formulary Drugs Starting with the Letter B in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACITRACIN 500[iU]/g 1 TUBE in 1 CARTON / 3.5 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in SD cover BACITRACIN 500[iU]/g 1 TUBE in 1 CARTON / 3.5 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in SD cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Baclofen 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in SD cover Baclofen 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BACTROBAN 2% CREAM ![Compare how all Medicare Part D PDP plans in SD cover BACTROBAN 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in SD cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in SD cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Balziva 6 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in SD cover Balziva 6 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in SD cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in SD cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BANZEL TABLET 400MG ![Compare how all Medicare Part D PDP plans in SD cover BANZEL TABLET 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BARACLUDE 0.05mg/mL 1 BOTTLE in 1 CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover BARACLUDE 0.05mg/mL 1 BOTTLE in 1 CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:1890 /90Days |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:90 /90Days |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:90 /90Days |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BENAZEPRIL HCL 20mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL 20mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:720 /90Days |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:360 /90Days |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:360 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:1440 /90Days |
Benztropine Mesylate 1mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Benztropine Mesylate 1mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic Drugs |
$3.00 | $0.00 | None |
Benztropine Mesylate 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Benztropine Mesylate 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic Drugs |
$3.00 | $0.00 | None |
BENZTROPINE MESYLATE INJECTION 2MG/2ML ![Compare how all Medicare Part D PDP plans in SD cover BENZTROPINE MESYLATE INJECTION 2MG/2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BENZTROPINE MESYLATE TABLETS ![Compare how all Medicare Part D PDP plans in SD cover BENZTROPINE MESYLATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic Drugs |
$3.00 | $0.00 | None |
BENZYL ALCOHOL 50 ML/ML TOPICAL LOTION [ULESFIA] ![Compare how all Medicare Part D PDP plans in SD cover BENZYL ALCOHOL 50 ML/ML TOPICAL LOTION [ULESFIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | None |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in SD cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in SD cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BETAMETHASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in SD cover BETAMETHASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in SD cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAMETHASONE DP 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in SD cover BETAMETHASONE DP 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAMETHASONE VA 0.1% LOTION ![Compare how all Medicare Part D PDP plans in SD cover BETAMETHASONE VA 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAMETHASONE VALERATE CREAM ![Compare how all Medicare Part D PDP plans in SD cover BETAMETHASONE VALERATE CREAM .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in SD cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM ![Compare how all Medicare Part D PDP plans in SD cover BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
32% | 32% | P Q:45 /90Days |
Betaxolol 20mg/1 100 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Betaxolol 20mg/1 100 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAXOLOL HCL 0.5% EYE DROP ![Compare how all Medicare Part D PDP plans in SD cover BETAXOLOL HCL 0.5% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETAXOLOL TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in SD cover BETAXOLOL TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETHANECHOL CHLORICDE TABLET ![Compare how all Medicare Part D PDP plans in SD cover BETHANECHOL CHLORICDE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETHANECHOL CHLORIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BETHANECHOL CHLORIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETHANECHOL CHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in SD cover BETHANECHOL CHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in SD cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICALUTAMIDE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in SD cover BICALUTAMIDE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in SD cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in SD cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in SD cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in SD cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in SD cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BICNU 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in SD cover BICNU 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | None |
BIDIL TABLET 20MG/37.5MG ![Compare how all Medicare Part D PDP plans in SD cover BIDIL TABLET 20MG/37.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:540 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BILTRICIDE 600MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BILTRICIDE 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in SD cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in SD cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in SD cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BLEPHAMIDE 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in SD cover BLEPHAMIDE 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | None |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in SD cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | None |
BONIVA 150MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BONIVA 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BOOSTRIX 8; 2.5; 8; 5; 2.5ug/0.5mL; ug/0.5mL; ug/0.5mL; [iU]/0.5mL; [iU]/0.5mL ![Compare how all Medicare Part D PDP plans in SD cover BOOSTRIX 8; 2.5; 8; 5; 2.5ug/0.5mL; ug/0.5mL; ug/0.5mL; [iU]/0.5mL; [iU]/0.5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BOOSTRIX 8; 2.5; 8; 5; 2.5ug/0.5mL; ug/0.5mL; ug/0.5mL; [iU]/0.5mL; [iU]/0.5mL ![Compare how all Medicare Part D PDP plans in SD cover BOOSTRIX 8; 2.5; 8; 5; 2.5ug/0.5mL; ug/0.5mL; ug/0.5mL; [iU]/0.5mL; [iU]/0.5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BRIELLYN ![Compare how all Medicare Part D PDP plans in SD cover BRIELLYN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BRILINTA 90mg/1 60 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover BRILINTA 90mg/1 60 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Brimonidine Tartrate 1.5mg/mL ![Compare how all Medicare Part D PDP plans in SD cover Brimonidine Tartrate 1.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in SD cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Bromday 0.9mg/mL ![Compare how all Medicare Part D PDP plans in SD cover Bromday 0.9mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Bromfenac 1.035mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 2.5 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in SD cover Bromfenac 1.035mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 2.5 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Bromocriptine mesylate 2.5mg/1 24 BOTTLE in 1 CARTON / 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Bromocriptine mesylate 2.5mg/1 24 BOTTLE in 1 CARTON / 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in SD cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
$95.00 | $190.00 | P Q:360 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUDEPRION SR 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in SD cover BUDEPRION SR 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:180 /90Days |
BUDEPRION SR 150MG TABLET SA ![Compare how all Medicare Part D PDP plans in SD cover BUDEPRION SR 150MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:180 /90Days |
BUDEPRION XL 300MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in SD cover BUDEPRION XL 300MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:90 /90Days |
BUDEPRION XL TABLETS 150MG 500 TABLETS BOT ![Compare how all Medicare Part D PDP plans in SD cover BUDEPRION XL TABLETS 150MG 500 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:270 /90Days |
BUDESONIDE 0.25 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in SD cover BUDESONIDE 0.25 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in SD cover BUDESONIDE 0.5 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | P |
Budesonide 3mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in SD cover Budesonide 3mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SD cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUMETANIDE 0.5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in SD cover BUMETANIDE 0.5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUMETANIDE 1MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in SD cover BUMETANIDE 1MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic Drugs |
$3.00 | $0.00 | None |
BUMETANIDE 2MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in SD cover BUMETANIDE 2MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPHENYL 500MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUPHENYL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in SD cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BUPRENEX 0.3MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in SD cover BUPRENEX 0.3MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in SD cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Buprenorphine HCl 2mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Buprenorphine HCl 2mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Buprenorphine HCl 8mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Buprenorphine HCl 8mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUPROBAN ER TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUPROBAN ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | P Q:180 /90Days |
BUPROPION HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUPROPION HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:180 /90Days |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in SD cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:180 /90Days |
BUPROPION HCL TABLET 100MG ![Compare how all Medicare Part D PDP plans in SD cover BUPROPION HCL TABLET 100MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bupropion Hydrochloride 150mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Bupropion Hydrochloride 150mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | Q:180 /90Days |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in SD cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in SD cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUSPIRONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in SD cover BUSPIRONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | None |
BUSULFEX 6mg/mL ![Compare how all Medicare Part D PDP plans in SD cover BUSULFEX 6mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in SD cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic Drugs |
$9.00 | $21.00 | P Q:30 /90Days |
BYDUREON 2 MG VIAL ![Compare how all Medicare Part D PDP plans in SD cover BYDUREON 2 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BYETTA 10ug/0.04mL ![Compare how all Medicare Part D PDP plans in SD cover BYETTA 10ug/0.04mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:7 /90Days |
BYETTA 5MCG/0.02ML PEN INJ ![Compare how all Medicare Part D PDP plans in SD cover BYETTA 5MCG/0.02ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | Q:7 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bystolic 10mg/1 100 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in SD cover Bystolic 10mg/1 100 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Bystolic 2.5mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Bystolic 2.5mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
Bystolic 5mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Bystolic 5mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |
BYSTOLIC TABLETS 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in SD cover BYSTOLIC TABLETS 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
$45.00 | $90.00 | None |