Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


2012 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

Community CCRx Basic (PDP) (S5803-077-0)
Tier 1 (1399)
Tier 2 (779)
Tier 3 (521)
Tier 4 (320)

Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2012 Medicare Part D Plan Formulary Information
Community CCRx Basic (PDP) (S5803-077-0)
Benefit Details           
The Community CCRx Basic (PDP) (S5803-077-0)
Formulary Drugs Starting with the Letter N

in CMS PDP Region 8 which includes: NC
Drugs Starting with Letter N

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
NABUMETONE 500MG TABLET   1 Generic Drugs $2.00N/ANone
NABUMETONE 750MG TABLET   1 Generic Drugs $2.00N/ANone
NADOLOL 20MG TABLET   1 Generic Drugs $2.00N/ANone
NADOLOL TABLETS   1 Generic Drugs $2.00N/ANone
NADOLOL TABLETS   1 Generic Drugs $2.00N/ANone
NAFCILLIN FOR INJECTION 1 GM/ML   3 Non-Preferred Brand Drugs 47%N/ANone
NAGLAZYME 5MG/5ML VIAL   4 Specialty Tier Drugs 25%N/AP
NALOXONE 1MG/ML SYRINGE   1 Generic Drugs $2.00N/ANone
NALOXONE HCL INJECTION 0.4MG 10 X 1ML CTG   1 Generic Drugs $2.00N/ANone
NALTREXONE HCL 50MG TABLET 100 BLPK   1 Generic Drugs $2.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAMENDA 10MG TABLET   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NAMENDA 10MG/5ML SOLUTION   2 Preferred Brand Drugs 25%N/AQ:360
/30Days
NAMENDA 5-10MG TITRATION PK   2 Preferred Brand Drugs 25%N/AQ:49
/365Days
NAMENDA 5MG TABLET   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NAPROXEN 125MG/5ML SUSPEN   1 Generic Drugs $2.00N/ANone
NAPROXEN 250 MG ORAL TABLET   1 Generic Drugs $2.00N/ANone
NAPROXEN 375MG TABLET EC   1 Generic Drugs $2.00N/ANone
NAPROXEN 500MG TABLET EC   1 Generic Drugs $2.00N/ANone
Naproxen 500mg/1 500 TABLET in 1 BOTTLE   1 Generic Drugs $2.00N/ANone
NAPROXEN SODIUM 275 MG ORAL TABLET   1 Generic Drugs $2.00N/ANone
Naproxen Sodium 550mg/1   1 Generic Drugs $2.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAPROXEN TABLET 375MG (500 CT)   1 Generic Drugs $2.00N/ANone
NARATRIPTAN TABLETS   1 Generic Drugs $2.00N/AQ:12
/30Days
NARATRIPTAN TABLETS   1 Generic Drugs $2.00N/AQ:12
/30Days
NASONEX 50ug/1 120 SPRAY, METERED in 1 BOTTLE, PUMP   2 Preferred Brand Drugs 25%N/AQ:34
/30Days
NATACYN EYE DROPS   3 Non-Preferred Brand Drugs 47%N/ANone
Nateglinide 120mg/1 90 TABLET in 1 BOTTLE   1 Generic Drugs $2.00N/AQ:90
/30Days
Nateglinide 60mg/1 90 TABLET in 1 BOTTLE   1 Generic Drugs $2.00N/AQ:90
/30Days
NEBUPENT 300MG INHAL POWDER   3 Non-Preferred Brand Drugs 47%N/AP
NECON 0.5/35-28 TABLET   1 Generic Drugs $2.00N/AQ:28
/28Days
NECON 1/35-28 TABLET   1 Generic Drugs $2.00N/AQ:28
/28Days
NECON 10/11-28 TABLET   1 Generic Drugs $2.00N/AQ:28
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NECON 7 DAYS X 3 TABLET   1 Generic Drugs $2.00N/AQ:28
/28Days
NEFAZODONE HCL 150MG TABLET (60 CT)   1 Generic Drugs $2.00N/ANone
NEFAZODONE HCL 250MG TABLET   1 Generic Drugs $2.00N/ANone
NEFAZODONE HCL 50MG TABLET   1 Generic Drugs $2.00N/ANone
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT   1 Generic Drugs $2.00N/ANone
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT   1 Generic Drugs $2.00N/ANone
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT   1 Generic Drugs $2.00N/ANone
Neomycin and Polymyxin B Sulfates and Dexamethasone 1; 3.5; 10000mg/g; mg/g; [USP'U]/g 1 TUBE in 1   1 Generic Drugs $2.00N/ANone
NEOMYCIN SULFATE 500MG TABLET   1 Generic Drugs $2.00N/ANone
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT   1 Generic Drugs $2.00N/ANone
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS   1 Generic Drugs $2.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEOMYCIN/POLYMY/DEXA EYE DROPS 3.5MG/1ML   1 Generic Drugs $2.00N/ANone
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M   1 Generic Drugs $2.00N/ANone
NEOMYCIN/POLYMY/HYDRO OTIC SUS   1 Generic Drugs $2.00N/ANone
NEORAL 100MG GELATN CAPSULE   2 Preferred Brand Drugs 25%N/AP
NEORAL 100MG/ML SOLUTION   2 Preferred Brand Drugs 25%N/AP
NEORAL 25MG GELATIN CAPSULE   2 Preferred Brand Drugs 25%N/AP
NEPHRAMINE SOLUTION FOR INJECTION   3 Non-Preferred Brand Drugs 47%N/AP
NEULASTA 6MG/0.6ML SYRINGE   4 Specialty Tier Drugs 25%N/AP Q:1
/28Days
NEUPOGEN 300MCG/ML VIAL   4 Specialty Tier Drugs 25%N/AP Q:22
/21Days
NEUPOGEN 300ug/0.5mL 10 SYRINGE in 1 BOX / 0.5 mL in 1 SYRINGE   4 Specialty Tier Drugs 25%N/AP Q:7
/21Days
NEUPOGEN INJECTION 480MCG/0.8ML 10 X 0.8ML SYR   4 Specialty Tier Drugs 25%N/AP Q:11
/21Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEVANAC 0.1% DROPTAINER   3 Non-Preferred Brand Drugs 47%N/AQ:3
/30Days
nevirapine 200 mg tablet   3 Non-Preferred Brand Drugs 47%N/ANone
NEXAVAR TABLETS 200MG 120 BOT   4 Specialty Tier Drugs 25%N/AP Q:120
/30Days
NEXIUM 10mg/1 30 GRANULE, DELAYED RELEASE in 1 CARTON   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
NEXIUM 20MG CAPSULE   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
NEXIUM 40MG CAPSULE   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
NEXIUM IV 20MG VIAL   3 Non-Preferred Brand Drugs 47%N/AP
NEXIUM IV 40MG VIAL   3 Non-Preferred Brand Drugs 47%N/AP
NEXT CHOICE 0.75 MG TABLET   2 Preferred Brand Drugs 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIACOR 500MG TABLET   1 Generic Drugs $2.00N/ANone
NIASPAN 1000MG TABLET (90 CT)   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NIASPAN ER 500MG TABLET (90 CT)   2 Preferred Brand Drugs 25%N/AQ:90
/30Days
NIASPAN ER 750MG TABLET (90 CT)   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NICARDIPINE HYDROCHLORIDE CAPSULES   1 Generic Drugs $2.00N/ANone
NICARDIPINE HYDROCHLORIDE CAPSULES 30MG 500 BOT   1 Generic Drugs $2.00N/ANone
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL   3 Non-Preferred Brand Drugs 47%N/AQ:2688
/365Days
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL   3 Non-Preferred Brand Drugs 47%N/AQ:360
/365Days
NIFEDIAC CC 30MG TABLET SA   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDIAC CC 60MG TABLET SA   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDIAC CC 90MG TABLET SA   1 Generic Drugs $2.00N/AS
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIFEDICAL XL 30MG TABLET SR OSMOTIC PUSH 24HR   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDICAL XL 60MG TABLET SR OSMOTIC PUSH 24HR   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDIPINE TABLETS EXTENDED RELEASE   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDIPINE TABLETS EXTENDED RELEASE   1 Generic Drugs $2.00N/AS Q:30
/30Days
NIFEDIPINE TABLETS EXTENDED RELEASE   1 Generic Drugs $2.00N/AS
NILANDRON 150MG TABLET   3 Non-Preferred Brand Drugs 47%N/ANone
NIMODIPINE 30MG CAPSULE   3 Non-Preferred Brand Drugs 47%N/ANone
NITRO-BID 20mg/g 48 PACKET in 1 BOX / 1 g in 1 PACKET   2 Preferred Brand Drugs 25%N/ANone
NITRO-DUR 0.3MG/HR PATCH   3 Non-Preferred Brand Drugs 47%N/ANone
NITRO-DUR 0.8MG/HR PATCH INST.   3 Non-Preferred Brand Drugs 47%N/ANone
Nitrofurantoin 25mg/5mL   2 Preferred Brand Drugs 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NITROFURANTOIN MCR 50MG CAP   1 Generic Drugs $2.00N/ANone
Nitrofurantoin Monohydrate/Macrocrystals 25; 75mg/1; mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC   1 Generic Drugs $2.00N/ANone
NITROGLYCERIN .2MG/HR PATCH   1 Generic Drugs $2.00N/ANone
NITROGLYCERIN .4MG/HR PATCH   1 Generic Drugs $2.00N/ANone
NITROGLYCERIN .6MG/HR PATCH   1 Generic Drugs $2.00N/ANone
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX   1 Generic Drugs $2.00N/ANone
NITROSTAT 0.3MG TABLET SL   3 Non-Preferred Brand Drugs 47%N/ANone
NITROSTAT 0.4MG TABLET SL   3 Non-Preferred Brand Drugs 47%N/ANone
NITROSTAT 0.6MG TABLET SL   3 Non-Preferred Brand Drugs 47%N/ANone
NIZATIDINE 150MG CAPSULE   1 Generic Drugs $2.00N/ANone
NIZATIDINE 300 MG CAPSULE (100 CAPS)   2 Preferred Brand Drugs 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORA-BE 0.35MG TABLET   1 Generic Drugs $2.00N/AQ:28
/28Days
Norditropin 10mg/1.5mL 1 SYRINGE, PLASTIC in 1 CARTON / 1.5 mL in 1 SYRINGE, PLASTIC   4 Specialty Tier Drugs 25%N/AP Q:14
/28Days
Norditropin 15mg/1.5mL 1 SYRINGE, PLASTIC in 1 CARTON / 1.5 mL in 1 SYRINGE, PLASTIC   4 Specialty Tier Drugs 25%N/AP Q:14
/28Days
Norditropin 5mg/1.5mL 1 SYRINGE, PLASTIC in 1 CARTON / 1.5 mL in 1 SYRINGE, PLASTIC   4 Specialty Tier Drugs 25%N/AP Q:39
/28Days
NORDITROPIN NORDIFLEX INJECTION   4 Specialty Tier Drugs 25%N/AP Q:12
/28Days
NORETHINDRONE 5MG TABLET   1 Generic Drugs $2.00N/ANone
NORMOSOL -R INJ /D5W   3 Non-Preferred Brand Drugs 47%N/ANone
NORMOSOL-M AND DEXTROSE 5%   3 Non-Preferred Brand Drugs 47%N/ANone
NORMOSOL-R PH 7.4 IV SOLUTION   3 Non-Preferred Brand Drugs 47%N/ANone
NORPACE CR 100MG CAPSULE SA   3 Non-Preferred Brand Drugs 47%N/ANone
NORPACE CR 150MG CAPSULE SA   3 Non-Preferred Brand Drugs 47%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK in 1 CARTON / 21 TABLET in 1 BLISTER PACK   1 Generic Drugs $2.00N/AQ:28
/28Days
Nortrel (28 Day Regimen) 3 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK   1 Generic Drugs $2.00N/AQ:28
/28Days
NORTREL 1-0.035MG TABLET 28DAY   1 Generic Drugs $2.00N/AQ:28
/28Days
Nortrel 7/7/7 (28 Day Regimen) 6 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER   1 Generic Drugs $2.00N/AQ:28
/28Days
NORTRIPTYLINE 10MG/5ML SOL   1 Generic Drugs $2.00N/ANone
NORTRIPTYLINE HCL 25MG CAP   1 Generic Drugs $2.00N/ANone
NORTRIPTYLINE HCL 75MG CAPSULE   1 Generic Drugs $2.00N/ANone
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE in 1 BOTTLE   1 Generic Drugs $2.00N/ANone
Nortriptyline Hydrochloride 50mg/1 500 CAPSULE in 1 BOTTLE   1 Generic Drugs $2.00N/ANone
NORVIR 100 MG TABLET   2 Preferred Brand Drugs 25%N/ANone
NORVIR 100mg/1 30 CAPSULE in 1 BOTTLE   2 Preferred Brand Drugs 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORVIR 80MG/ML ORAL SOLUTION   2 Preferred Brand Drugs 25%N/ANone
Novolin 100[iU]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL   2 Preferred Brand Drugs 25%N/ANone
Novolin 100[USP'U]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL   2 Preferred Brand Drugs 25%N/ANone
Novolin R 100[iU]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL   2 Preferred Brand Drugs 25%N/ANone
NOVOLOG 100U/ML VIAL   2 Preferred Brand Drugs 25%N/ANone
NOVOLOG FLEXPEN SYRINGE   2 Preferred Brand Drugs 25%N/ANone
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML   2 Preferred Brand Drugs 25%N/ANone
NOVOLOG MIX 70/30 VIAL   2 Preferred Brand Drugs 25%N/ANone
NOXAFIL 200MG/5ML SUSPENSION ORAL   4 Specialty Tier Drugs 25%N/AP Q:600
/30Days
NUCYNTA ER 100mg/1 60 TABLET, FILM COATED   2 Preferred Brand Drugs 25%N/AQ:120
/30Days
NUCYNTA ER 150mg/1 60 TABLET, FILM COATED   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NUCYNTA ER 200mg/1 60 TABLET, FILM COATED   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NUCYNTA ER 250mg/1 60 TABLET, FILM COATED   2 Preferred Brand Drugs 25%N/AQ:60
/30Days
NUCYNTA ER 50mg/1 60 TABLET, FILM COATED   2 Preferred Brand Drugs 25%N/AQ:120
/30Days
NULOJIX 250mg/1 1 VIAL, SINGLE-USE in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in   4 Specialty Tier Drugs 25%N/AP
NULYTELY WITH FLAVOR PACKS POWDER FOR SOLUTION 420;1.48;MG;MG;GM; 4 L BOT   2 Preferred Brand Drugs 25%N/ANone
NUTROPIN 10 MG VIAL   4 Specialty Tier Drugs 25%N/AP Q:6
/28Days
NUTROPIN AQ 20MG/2ML PEN CART SOMATROPIN   4 Specialty Tier Drugs 25%N/AP Q:12
/28Days
NUTROPIN AQ NUSPIN SOLUTION   4 Specialty Tier Drugs 25%N/AP Q:44
/28Days
NUTROPIN AQ PEN CARTRIDGE 10MG/2 ML   4 Specialty Tier Drugs 25%N/AP Q:22
/28Days
NYAMYC 100000 U/G POWDER   1 Generic Drugs $2.00N/ANone
Nystatin 100000[USP'U]/g   1 Generic Drugs $2.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Nystatin 100000[USP'U]/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE   1 Generic Drugs $2.00N/ANone
Nystatin 100000[USP'U]/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE   1 Generic Drugs $2.00N/ANone
Nystatin 100000[USP'U]/mL   1 Generic Drugs $2.00N/ANone
NYSTATIN TABLET 500000U (100 CT)   1 Generic Drugs $2.00N/ANone
NYSTATIN/TRIAMCINOLONE CRM   1 Generic Drugs $2.00N/ANone
NYSTATIN/TRIAMCINOLONE OINT 10000UNT/1MG   1 Generic Drugs $2.00N/ANone
NYSTOP 100000U/GM POWDER   1 Generic Drugs $2.00N/ANone

Chart Legend:

Below are a few notes to help you understand the above 2012 Medicare Part D Community CCRx Basic (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $320 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2930) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2012 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2012 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.