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2012 Medicare Part D and Medicare Advantage Plan Formulary Browser

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First Health Part D Value Plus (PDP) (S5768-147-0)
Tier 1 (1639)
Tier 2 (290)
Tier 3 (1041)
Tier 4 (250)

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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
First Health Part D Value Plus (PDP) (S5768-147-0)
Benefit Details           
The First Health Part D Value Plus (PDP) (S5768-147-0)
Formulary Drugs Starting with the Letter A

in CMS PDP Region 24 which includes: KS
Drugs Starting with Letter A

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG   1 Preferred Generic Drugs $0.00N/ANone
A-HYDROCORT 100MG VIAL   1 Preferred Generic Drugs $0.00N/ANone
A-METHAPRED INJ 40MG   1 Preferred Generic Drugs $0.00N/ANone
ABACAVIR TAB 300MG   3 Non-Preferred Brand Drugs 39%N/ANone
ABILIFY 10MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ABILIFY 15MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ABILIFY 1MG/ML SOLUTION   3 Non-Preferred Brand Drugs 39%N/AQ:900
/30Days
ABILIFY 20MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ABILIFY 2MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ABILIFY 30MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ABILIFY 5MG TABLET (OTSUKA)   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ABILIFY DISCMELT 10MG TABLET   3 Non-Preferred Brand Drugs 39%N/AP Q:60
/30Days
ABILIFY DISCMELT 15MG TABLET   3 Non-Preferred Brand Drugs 39%N/AP Q:60
/30Days
ABILIFY INJ 9.75MG   3 Non-Preferred Brand Drugs 39%N/ANone
Acarbose 100mg/1 90 TABLET in 1 BOTTLE,   1 Preferred Generic Drugs $0.00N/ANone
acarbose 50 mg tablet   1 Preferred Generic Drugs $0.00N/ANone
ACARBOSE TABLETS   1 Preferred Generic Drugs $0.00N/ANone
ACEBUTOLOL 200MG CAPSULE   1 Preferred Generic Drugs $0.00N/ANone
ACEBUTOLOL 400MG CAPSULE   1 Preferred Generic Drugs $0.00N/ANone
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE   2 Preferred Brand Drugs 25%N/ANone
Acetaminophen and Codeine Phosphate 300; 60mg/1; mg/1 500 TABLET in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/AQ:390
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD   1 Preferred Generic Drugs $0.00N/AQ:4950
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)   1 Preferred Generic Drugs $0.00N/AQ:390
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)   1 Preferred Generic Drugs $0.00N/AQ:390
/30Days
ACETAZOLAMIDE 125MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
ACETAZOLAMIDE 250MG TABLET (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT   1 Preferred Generic Drugs $0.00N/ANone
ACETIC ACID 2% SOLUTION NON-ORAL   1 Preferred Generic Drugs $0.00N/ANone
ACETYLCYSTEINE 10% VIAL   1 Preferred Generic Drugs $0.00N/AP
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN   1 Preferred Generic Drugs $0.00N/AP
ACIPHEX 20MG TABLET EC   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ACTHIB VACCINE VIAL 10-24UNT/5ML   3 Non-Preferred Brand Drugs 39%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACTICIN 5% CREAM   1 Preferred Generic Drugs $0.00N/ANone
ACTIMMUNE SOLUTION FOR INJECTION 100MCG   4 Specialty Tier Drugs 33%N/ANone
ACTIVELLA 0.5-0.1MG TABLET 28 DLPK   3 Non-Preferred Brand Drugs 39%N/ANone
Actonel 150mg/1 36 DOSE PACK in 1 CASE / 1 TRAY in 1 DOSE PACK / 1 TABLET, FILM COATED in 1 TRAY   3 Non-Preferred Brand Drugs 39%N/AS Q:1
/30Days
Actonel 30mg/1 12 BOTTLE in 1 CASE / 30 TABLET, FILM COATED in 1 BOTTLE   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
Actonel 35mg/1 36 DOSE PACK in 1 CASE / 1 TRAY in 1 DOSE PACK / 4 TABLET, FILM COATED in 1 TRAY   3 Non-Preferred Brand Drugs 39%N/AS Q:4
/28Days
Actonel 5mg/1 12 BOTTLE in 1 CASE / 30 TABLET, FILM COATED in 1 BOTTLE   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ACTOS 15MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ACTOS 30MG TABLET (500 CT)   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ACTOS 45MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Acyclovir 200mg/1   1 Preferred Generic Drugs $0.00N/ANone
Acyclovir 200mg/5mL 473 mL in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
Acyclovir 400mg/1 100 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK   1 Preferred Generic Drugs $0.00N/ANone
Acyclovir 800mg/1 100 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK   1 Preferred Generic Drugs $0.00N/ANone
ACYCLOVIR SODIUM 500MG VIAL   1 Preferred Generic Drugs $0.00N/ANone
ADACEL VIAL 2UNT/5UNT   3 Non-Preferred Brand Drugs 39%N/ANone
ADAGEN 250U/ML VIAL   4 Specialty Tier Drugs 33%N/AP
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]   4 Specialty Tier Drugs 33%N/AP Q:2
/30Days
ADCIRCA TABLETS 20MG 60 BOT   4 Specialty Tier Drugs 33%N/AP Q:60
/30Days
ADVAIR DISKUS MIS 100/50   3 Non-Preferred Brand Drugs 39%N/AS Q:60
/30Days
ADVAIR DISKUS MIS 250/50   3 Non-Preferred Brand Drugs 39%N/AS Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADVAIR DISKUS MIS 500/50   3 Non-Preferred Brand Drugs 39%N/AS Q:60
/30Days
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER   3 Non-Preferred Brand Drugs 39%N/AS Q:12
/30Days
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   3 Non-Preferred Brand Drugs 39%N/AS Q:12
/30Days
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   3 Non-Preferred Brand Drugs 39%N/AS Q:12
/30Days
ADVICOR ER 20-750MG TABLET (90 CT)   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
ADVICOR EXTENDED RELEASE TABLETS 20;1000MG;MG 90 BOTPL   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
ADVICOR EXTENDED RELEASE TABLETS 20;500MG;MG 90 BOTPL   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ADVICOR EXTENDED RELEASE TABLETS 40;1000MG;MG 90 BOTPL   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AFEDITAB CR 30MG TABLET SA   3 Non-Preferred Brand Drugs 39%N/ANone
AFEDITAB CR 60MG TABLET SA   3 Non-Preferred Brand Drugs 39%N/ANone
Afinitor 7.5mg/1 28 BLISTER PACK in 1 CARTON / 1 TABLET in 1 BLISTER PACK   4 Specialty Tier Drugs 33%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AFINITOR TABLETS 10 MG   4 Specialty Tier Drugs 33%N/AP Q:30
/30Days
AFINITOR TABLETS 2.5 MG   4 Specialty Tier Drugs 33%N/AP Q:30
/30Days
AFINITOR TABLETS 5 MG   4 Specialty Tier Drugs 33%N/AP Q:30
/30Days
AGGRENOX 25-200MG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
AK-CON 0.1% EYE DROPS   1 Preferred Generic Drugs $0.00N/ANone
AKNE-MYCIN 2% OINTMENT   3 Non-Preferred Brand Drugs 39%N/ANone
AKTOB 0.3% EYE DROPS   1 Preferred Generic Drugs $0.00N/ANone
ALAMAST 0.1% DROPS   3 Non-Preferred Brand Drugs 39%N/AQ:20
/30Days
ALBENZA 200 MG TABLET   3 Non-Preferred Brand Drugs 39%N/ANone
Albuterol Sulfate 0.63mg/3mL 25 POUCH in 1 CARTON / 5 VIAL in 1 POUCH / 3 mL in 1 VIAL   1 Preferred Generic Drugs $0.00N/AP
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   1 Preferred Generic Drugs $0.00N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALBUTEROL SULFATE 4MG TABLET SR 12HR   1 Preferred Generic Drugs $0.00N/ANone
ALBUTEROL SULFATE 8MG TABLET SR 12HR   1 Preferred Generic Drugs $0.00N/ANone
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   1 Preferred Generic Drugs $0.00N/AP
ALBUTEROL SULFATE SOLUTION FOR INHALATION   1 Preferred Generic Drugs $0.00N/AP
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   1 Preferred Generic Drugs $0.00N/ANone
ALBUTEROL SULFATE TABLET 2MG (500 CT)   1 Preferred Generic Drugs $0.00N/ANone
ALBUTEROL TABLET 4MG (500 CT)   1 Preferred Generic Drugs $0.00N/ANone
ALCLOMETASONE DIPROPIONATE 0.05% CREAM   1 Preferred Generic Drugs $0.00N/ANone
Alclometasone Dipropionate 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE   1 Preferred Generic Drugs $0.00N/ANone
ALDURAZYME 2.9MG/5ML VIAL   4 Specialty Tier Drugs 33%N/AP
ALENDRONATE SODIUM 10MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALENDRONATE SODIUM 40MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
ALENDRONATE SODIUM 5MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
ALENDRONATE SODIUM 70mg/1   1 Preferred Generic Drugs $0.00N/ANone
ALENDRONATE SODIUM TABLET 35MG 20 CRTN   1 Preferred Generic Drugs $0.00N/ANone
ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
ALIMTA 500MG VIAL   4 Specialty Tier Drugs 33%N/AP
ALINIA 100MG/5ML SUSPENSION   3 Non-Preferred Brand Drugs 39%N/ANone
ALINIA 500MG TABLET   3 Non-Preferred Brand Drugs 39%N/ANone
Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET in 1 BLISTER PACK   1 Preferred Generic Drugs $0.00N/ANone
ALLOPURINOL TABLETS   1 Preferred Generic Drugs $0.00N/ANone
ALOCRIL 2% EYE DROPS   3 Non-Preferred Brand Drugs 39%N/AQ:10
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALOMIDE 0.1% EYE DROPS   3 Non-Preferred Brand Drugs 39%N/ANone
ALORA 0.025MG PATCH   3 Non-Preferred Brand Drugs 39%N/AQ:8
/28Days
ALORA 0.05MG PATCH   3 Non-Preferred Brand Drugs 39%N/AQ:8
/28Days
ALORA 0.075MG PATCH   3 Non-Preferred Brand Drugs 39%N/AQ:8
/28Days
ALORA 0.1MG PATCH   3 Non-Preferred Brand Drugs 39%N/AQ:8
/28Days
ALPHAGAN P 0.1% DROPS   2 Preferred Brand Drugs 25%N/AQ:10
/30Days
ALPHAGAN P 0.15% EYE DROPS   2 Preferred Brand Drugs 25%N/AQ:10
/30Days
ALREX 0.2% EYE DROPS   2 Preferred Brand Drugs 25%N/AQ:15
/30Days
ALTABAX 10mg/g 30 g in 1 TUBE   3 Non-Preferred Brand Drugs 39%N/AQ:15
/30Days
ALTOPREV 20MG TABLET SR 24HR   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ALTOPREV 40MG TABLET SR 24HR   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALTOPREV 60MG TABLET SR 24HR   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ALVESCO 160MCG/ACT AERS   3 Non-Preferred Brand Drugs 39%N/AQ:12
/30Days
ALVESCO 80MCG/ACT AERS   3 Non-Preferred Brand Drugs 39%N/AQ:12
/30Days
AMANTADINE 100MG CAPSULE   1 Preferred Generic Drugs $0.00N/ANone
AMANTADINE 100MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMCINONIDE 0.1% CREAM   1 Preferred Generic Drugs $0.00N/ANone
AMCINONIDE 0.1% LOTION   1 Preferred Generic Drugs $0.00N/ANone
AMCINONIDE 0.1% OINTMENT 60GM TUBE   1 Preferred Generic Drugs $0.00N/ANone
Amethia 2 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/AQ:91
/90Days
Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK in 1 CARTON / 28 TABLET in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/AQ:28
/28Days
AMIFOSTINE FOR INJECTION 500MG/VIAL   4 Specialty Tier Drugs 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIKACIN 250MG/ML VIAL   1 Preferred Generic Drugs $0.00N/ANone
AMIKACIN 50MG/ML VIAL   1 Preferred Generic Drugs $0.00N/ANone
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT   1 Preferred Generic Drugs $0.00N/ANone
AMINOPHYLLINE 100MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMINOPHYLLINE 200MG TABLET (1000 CT)   1 Preferred Generic Drugs $0.00N/ANone
Aminophylline 25mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 10 mL in 1 VIA   1 Preferred Generic Drugs $0.00N/ANone
AMINOSYN 10% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN 3.5% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN 5% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN 7% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN 8.5% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN HBC INJECTION SULFITE FREE 7%   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 10% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 15% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 3.5% IN D25W IV   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 3.5% IN D5W IV   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 3.5% M/D5W IV   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 3.5% W/ELEC DEX   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 4.25% IN D10W   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 4.25% IN D20W   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 4.25% W/ELEC DW   3 Non-Preferred Brand Drugs 39%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN II 4.25%-D25W IV   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 5% IN D25W IV   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 7% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 8.5% ELECTROLYT   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN II 8.5% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN M 3.5% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN PF INJECTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN-HF 8% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMINOSYN-PF 7% IV SOLUTION   3 Non-Preferred Brand Drugs 39%N/AP
AMIODARONE HCL 400MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Amiodarone hydrochloride 200mg/1   1 Preferred Generic Drugs $0.00N/ANone
AMITIZA 8MCG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
AMITIZA CAPSULES 24MCG 60 CAP BOT   3 Non-Preferred Brand Drugs 39%N/AQ:60
/30Days
AMITRIP/CDP 25-10 TABLET   3 Non-Preferred Brand Drugs 39%N/ANone
AMITRIP/PERPHEN 10-2 TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIP/PERPHEN 10-4 TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIP/PERPHEN 25-2 TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIP/PERPHEN 25-4 TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIP/PERPHEN 50-4 TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIPTYLINE HCL 100MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMITRIPTYLINE HCL 10MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMITRIPTYLINE HCL 150 MG TAB   1 Preferred Generic Drugs $0.00N/ANone
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT   1 Preferred Generic Drugs $0.00N/ANone
AMLODIPINE BESYLATE 10MG TABLET (90 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMLODIPINE BESYLATE 5MG TABLET (90 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AMMONIUM LACTATE 12% CREAM   1 Preferred Generic Drugs $0.00N/ANone
AMMONIUM LACTATE 12% LOTION   1 Preferred Generic Drugs $0.00N/ANone
Amnesteem 10mg/1 3 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/ANone
Amnesteem 20mg/1 3 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/ANone
Amnesteem 40mg/1 3 BLISTER PACK in 1 CARTON / 10 CAPSULE in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/ANone
AMOX TR-K CLV 500-125 MG TAB   1 Preferred Generic Drugs $0.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL   1 Preferred Generic Drugs $0.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE   1 Preferred Generic Drugs $0.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE   1 Preferred Generic Drugs $0.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL   1 Preferred Generic Drugs $0.00N/ANone
AMOXAPINE 100MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMOXAPINE 150MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMOXAPINE 25MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMOXAPINE 50MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN 125MG TABLET CHEW   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN 200MG TABLET CHEW   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN 250MG CAPSULE   1 Preferred Generic Drugs $0.00N/ANone
Amoxicillin 250mg/1 500 TABLET, CHEWABLE in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXICILLIN 500MG TABLET (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN 875MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG   3 Non-Preferred Brand Drugs 39%N/ANone
AMOXICILLIN CAP 500MG   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Preferred Generic Drugs $0.00N/ANone
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE CAP 10MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPHETAMINE CAP 15MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AMPHETAMINE CAP 20MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AMPHETAMINE CAP 25MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AMPHETAMINE CAP 30MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:60
/30Days
AMPHETAMINE CAP 5MG ER   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AMPHETAMINE SALT COMBO 12.5MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE SALT COMBO 15MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE SALT COMBO 30MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE SALT COMBO 7.5MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE SALTS 20MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
AMPHETAMINE SALTS 5 MG TAB   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
amphotericin b 50mg/10mL 10 mL in 1 VIAL   1 Preferred Generic Drugs $0.00N/ANone
Ampicillin 125mg/1 10 VIAL in 1 BOX / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL   3 Non-Preferred Brand Drugs 39%N/ANone
AMPICILLIN CAPSULES 250MG 100 BOT   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN CAPSULES 500MG 100 BOT   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN FOR INJECTION POWDER   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT   1 Preferred Generic Drugs $0.00N/ANone
AMPICILLIN POWDER FOR INJECTION 1 GM/ML   1 Preferred Generic Drugs $0.00N/ANone
ampicillin-sulbactam 15 gm vl   3 Non-Preferred Brand Drugs 39%N/ANone
ANADROL-50 50MG TABLET (100 CT)   2 Preferred Brand Drugs 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
Anagrelide Hydrochloride 1mg/1 100 CAPSULE in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
ANASTROZOLE TABLETS   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
ANCOBON 250MG CAPSULE   4 Specialty Tier Drugs 33%N/ANone
ANCOBON 500MG CAPSULE   4 Specialty Tier Drugs 33%N/ANone
ANDROGEL 1%(50MG) GEL PACKET   2 Preferred Brand Drugs 25%N/AP
Androgel 16.2mg/g 1 BOTTLE, PUMP in 1 CARTON / 88 g in 1 BOTTLE, PUMP   2 Preferred Brand Drugs 25%N/AP
ANGELIQ 1-0.5MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ANTABUSE 250MG TABLET   2 Preferred Brand Drugs 25%N/ANone
ANTABUSE 500MG TABLET   2 Preferred Brand Drugs 25%N/ANone
ANTARA CAPSULES   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ANTARA CAPSULES   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
APAP-CAFFEINE-DIHYDROCODE TAB 30 EA   3 Non-Preferred Brand Drugs 39%N/AQ:150
/30Days
APIDRA 100UNITS/ML VIAL   3 Non-Preferred Brand Drugs 39%N/ANone
APOKYN 30mg/3mL 5 CARTRIDGE in 1 CARTON / 3 mL in 1 CARTRIDGE   4 Specialty Tier Drugs 33%N/AP
Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 10 mL in 1 BOTTLE, DROPPER   3 Non-Preferred Brand Drugs 39%N/ANone
APRI 0.15-0.03 TABLET   1 Preferred Generic Drugs $0.00N/AQ:28
/28Days
APRISO CP24   2 Preferred Brand Drugs 25%N/AQ:120
/30Days
APTIVUS 250MG CAPSULE   4 Specialty Tier Drugs 33%N/ANone
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   4 Specialty Tier Drugs 33%N/ANone
Aralast NP 1 KIT in 1 CARTON   4 Specialty Tier Drugs 33%N/AP
ARANELLE 7-9-5 TABLET   1 Preferred Generic Drugs $0.00N/AQ:28
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARCALYST INJECTION 220MG/VIAL   4 Specialty Tier Drugs 33%N/AP Q:8
/30Days
Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE in 1 BLISTER PACK   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
ARTHROTEC 50 50MG TABLET -200MCG (60 CT)   3 Non-Preferred Brand Drugs 39%N/AS
ARTHROTEC 75 TABLET EC   3 Non-Preferred Brand Drugs 39%N/AS
ASACOL 400mg/1 12 BOTTLE in 1 CASE / 180 TABLET, DELAYED RELEASE in 1 BOTTLE   3 Non-Preferred Brand Drugs 39%N/ANone
ASACOL HD 800mg/1 12 BOTTLE in 1 CASE / 180 TABLET, DELAYED RELEASE in 1 BOTTLE   3 Non-Preferred Brand Drugs 39%N/ANone
Ascomp with Codeine 325; 50; 40; 30mg/1; mg/1; mg/1; mg/1 500 CAPSULE in 1 BOTTLE, PLASTIC   3 Non-Preferred Brand Drugs 39%N/ANone
ASMANEX TWISTHALER 110 MCG #30   2 Preferred Brand Drugs 25%N/AQ:1
/30Days
ASMANEX TWISTHALER 220MCG #120   2 Preferred Brand Drugs 25%N/AQ:1
/30Days
ASMANEX TWISTHALER 220MCG #30   2 Preferred Brand Drugs 25%N/AQ:1
/30Days
ASMANEX TWISTHALER 220MCG #60   2 Preferred Brand Drugs 25%N/AQ:1
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ASTEPRO 0.15% NASAL SPRAY 30 ML   2 Preferred Brand Drugs 25%N/AQ:30
/25Days
ATACAND 16MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND 32MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND 4MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND 8MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND HCT 16/12.5MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND HCT 32/12.5MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATACAND HCT TABLETS 32;25MG;MG 90 TABLETS BOT   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
ATENOLOL 100mg/1 100 TABLET in 1 BOTTLE, PLASTIC   1 Preferred Generic Drugs $0.00N/ANone
Atenolol 25mg/1 100 TABLET in 1 BOTTLE, PLASTIC   1 Preferred Generic Drugs $0.00N/ANone
ATENOLOL TABLET USP 50MG (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   1 Preferred Generic Drugs $0.00N/ANone
ATORVASTATIN 10 MG TABLET   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
ATORVASTATIN 20 MG TABLET   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
ATORVASTATIN 40 MG TABLET   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
ATORVASTATIN 80 MG TABLET   1 Preferred Generic Drugs $0.00N/AQ:30
/30Days
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC   4 Specialty Tier Drugs 33%N/AQ:30
/30Days
ATROVENT HFA AER 17MCG   2 Preferred Brand Drugs 25%N/AQ:26
/30Days
AUGMENTED BETAMETHASONE DIPROPIONATE OINTMENT   1 Preferred Generic Drugs $0.00N/ANone
AVALIDE 300-25MG TABLET   2 Preferred Brand Drugs 25%N/AQ:30
/30Days
AVASTIN 100MG/4ML VIAL   4 Specialty Tier Drugs 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVELOX 400MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AVELOX ABC PACK 400MG TABLET   3 Non-Preferred Brand Drugs 39%N/AQ:30
/30Days
AVELOX IV 400MG/250ML   3 Non-Preferred Brand Drugs 39%N/ANone
AVIANE 0.1-0.02 TABLET   1 Preferred Generic Drugs $0.00N/AQ:28
/28Days
AVODART 0.5MG SOFTGEL   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AVONEX ADMIN PACK 30MCG SYR   4 Specialty Tier Drugs 33%N/AP Q:4
/30Days
AVONEX ADMIN PACK 30MCG VL   4 Specialty Tier Drugs 33%N/AP Q:4
/30Days
AXERT 12.5MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:8
/30Days
AXERT 6.25MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:8
/30Days
AZASITE 1% DROPS   2 Preferred Brand Drugs 25%N/AQ:3
/14Days
AZATHIOPRINE 50MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZATHIOPRINE SOD 100MG VIAL   1 Preferred Generic Drugs $0.00N/ANone
AZELASTINE 137 MCG NASAL SPRAY   3 Non-Preferred Brand Drugs 39%N/ANone
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION   3 Non-Preferred Brand Drugs 39%N/ANone
AZELEX 20% CREAM 30GM TUBE   3 Non-Preferred Brand Drugs 39%N/ANone
AZILECT 0.5MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AZILECT 1MG TABLET   3 Non-Preferred Brand Drugs 39%N/AS Q:30
/30Days
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Preferred Generic Drugs $0.00N/ANone
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Preferred Generic Drugs $0.00N/ANone
AZITHROMYCIN 250 MG TABLET   1 Preferred Generic Drugs $0.00N/ANone
Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION   1 Preferred Generic Drugs $0.00N/ANone
Azithromycin 500mg/1 30 TABLET, FILM COATED in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Azithromycin 600mg/1 30 TABLET, FILM COATED in 1 BOTTLE   1 Preferred Generic Drugs $0.00N/ANone
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT   3 Non-Preferred Brand Drugs 39%N/ANone
AZTREONAM FOR INJECTION   1 Preferred Generic Drugs $0.00N/ANone

Chart Legend:

Below are a few notes to help you understand the above 2012 Medicare Part D First Health Part D Value Plus (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 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 wit 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 which tier the drug is in. 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.