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WellCare Signature (PDP) (S5967-066-0)
Tier 1 (1315)
Tier 2 (448)
Tier 3 (338)
Tier 4 (391)
Tier 5 (232)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
Cick on the first letter of your drug name to browse the formulary:

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M N O P Q R S T U V W X Y Z 0-9 
2012 Medicare Part D Plan Formulary Information
WellCare Signature (PDP) (S5967-066-0)
Benefit Details           
The WellCare Signature (PDP) (S5967-066-0)
Formulary Drugs Starting with the Letter Z

in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter Z

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
ZAFIRLUKAST TABLETS   1 Preferred Generic Drugs $0.00$0.00Q:62
/31Days
ZAFIRLUKAST TABLETS   1 Preferred Generic Drugs $0.00$0.00Q:62
/31Days
ZALEPLON 10MG CAPSULE   1 Preferred Generic Drugs $0.00$0.00None
ZALEPLON 5MG CAPSULE   1 Preferred Generic Drugs $0.00$0.00None
ZAVESCA 100MG CAPSULE   5 Specialty Tier Drugs 33%N/AP
ZAZOLE 0.4% CREAM WITH APPLICATOR   1 Preferred Generic Drugs $0.00$0.00None
ZAZOLE 0.8% CREAM WITH APPLICATOR   1 Preferred Generic Drugs $0.00$0.00None
ZELAPAR 1.25MG ODT TABLET   4 Non-Preferred Brand Drugs $90.00$225.00None
ZELBORAF 240mg/1 1 BOTTLE, PLASTIC in 1 CARTON / 120 TABLET, FILM COATED in 1 BOTTLE, PLASTIC   5 Specialty Tier Drugs 33%N/AP Q:248
/31Days
ZENPEP 109000; 20000; 68000[USP'U]/1; [USP'U]/1; [USP'U]/1 100 CAPSULE, DELAYED RELEASE in 1 BOTTLE   4 Non-Preferred Brand Drugs $90.00$225.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZENPEP 27000; 5000; 17000[USP'U]/1; [USP'U]/1; [USP'U]/1 100 CAPSULE, DELAYED RELEASE in 1 BOTTLE,   4 Non-Preferred Brand Drugs $90.00$225.00None
ZENPEP 55000; 10000; 34000[USP'U]/1; [USP'U]/1; [USP'U]/1 100 CAPSULE, DELAYED RELEASE in 1 BOTTLE,   4 Non-Preferred Brand Drugs $90.00$225.00None
ZENPEP 82000; 15000; 51000[USP'U]/1; [USP'U]/1; [USP'U]/1 100 CAPSULE, DELAYED RELEASE in 1 BOTTLE,   4 Non-Preferred Brand Drugs $90.00$225.00None
ZENPEP DR 25,000 UNITS CAPSULE   4 Non-Preferred Brand Drugs $90.00$225.00None
ZENPEP DR 3,000 UNITS CAPSULE   4 Non-Preferred Brand Drugs $90.00$225.00None
ZERIT 1MG/ML SOLUTION   4 Non-Preferred Brand Drugs $90.00$225.00None
ZETIA 10MG TABLET (90 CT)   4 Non-Preferred Brand Drugs $90.00$225.00Q:31
/31Days
ZIAGEN 20mg/mL 240 mL in 1 BOTTLE   3 Preferred Brand Drugs $45.00$112.50None
ZIAGEN 300mg/1 60 TABLET, FILM COATED in 1 BOTTLE   3 Preferred Brand Drugs $45.00$112.50None
ZIDOVUDINE 10MG/ML SYRUP   1 Preferred Generic Drugs $0.00$0.00None
Zidovudine 300mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC   1 Preferred Generic Drugs $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZIPRASIDONE HCL 20 MG CAPSULE   2 Non-Preferred Generic Drugs $20.00$50.00P Q:62
/31Days
ZIPRASIDONE HCL 40 MG CAPSULE   2 Non-Preferred Generic Drugs $20.00$50.00P Q:62
/31Days
ZIPRASIDONE HCL 60 MG CAPSULE   2 Non-Preferred Generic Drugs $20.00$50.00P Q:62
/31Days
ZIPRASIDONE HCL 80 MG CAPSULE   2 Non-Preferred Generic Drugs $20.00$50.00P Q:62
/31Days
ZIRGAN 1.5mg/g 1 TUBE, WITH APPLICATOR in 1 CARTON / 5 g in 1 TUBE, WITH APPLICATOR   4 Non-Preferred Brand Drugs $90.00$225.00None
ZOLINZA 100MG CAPSULE   5 Specialty Tier Drugs 33%N/AP
Zolpidem Tartrate 5mg/1 100 TABLET, FILM COATED in 1 BOTTLE   1 Preferred Generic Drugs $0.00$0.00Q:62
/31Days
ZOLPIDEM TARTRATE TABLETS   1 Preferred Generic Drugs $0.00$0.00Q:31
/31Days
Zometa 4mg/100mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE   4 Non-Preferred Brand Drugs $90.00$225.00P
ZOMETA 4MG/5ML VIAL   4 Non-Preferred Brand Drugs $90.00$225.00P
ZONISAMIDE 100MG CAPSULE (100 CT)   1 Preferred Generic Drugs $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Zonisamide 25mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC   1 Preferred Generic Drugs $0.00$0.00None
ZONISAMIDE 50MG CAPSULE (100 CT)   1 Preferred Generic Drugs $0.00$0.00None
Zortress 0.5mg/1 60 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK   5 Specialty Tier Drugs 33%N/AP
Zortress 0.75mg/1 60 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK   5 Specialty Tier Drugs 33%N/AP
ZORTRESS TABLETS   4 Non-Preferred Brand Drugs $90.00$225.00P Q:62
/31Days
ZOSTAVAX VIAL   4 Non-Preferred Brand Drugs $90.00$225.00None
ZOVIA 1/35-28 TABLET   1 Preferred Generic Drugs $0.00$0.00None
ZOVIA 1/50-28 TABLET   1 Preferred Generic Drugs $0.00$0.00None
ZOVIRAX 5% CREAM   4 Non-Preferred Brand Drugs $90.00$225.00None
ZOVIRAX 50mg/g   4 Non-Preferred Brand Drugs $90.00$225.00None
ZYLET 0.3%-0.5% SUSPENSION DROPS(FINAL DOSAGE FORM)(ML)   4 Non-Preferred Brand Drugs $90.00$225.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZYMAXID 5mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 2.5 mL in 1 BOTTLE, DROPPER   4 Non-Preferred Brand Drugs $90.00$225.00None
ZYPREXA 10MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA 10MG VIAL   4 Non-Preferred Brand Drugs $90.00$225.00Q:6
/31Days
ZYPREXA 15MG TABLET (1000 BOT)   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA 2.5MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA 20MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA 5MG TABLET (30 BOT)   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA 7.5MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA ZYDIS 10MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA ZYDIS 15MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
ZYPREXA ZYDIS 20MG TABLET   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ZYPREXA ZYDIS 5MG TABLET (30 BLPK)   4 Non-Preferred Brand Drugs $90.00$225.00P Q:31
/31Days
Zytiga 250mg/1 120 TABLET in 1 BOTTLE   5 Specialty Tier Drugs 33%N/AP
ZYVOX 100MG/5ML SUSPENSION   5 Specialty Tier Drugs 33%N/AP
ZYVOX 600MG TABLET   5 Specialty Tier Drugs 33%N/AP
ZYVOX 600MG/300ML IV SOLUTION   5 Specialty Tier Drugs 33%N/AP

Chart Legend:

Below are a few notes to help you understand the above 2012 Medicare Part D WellCare Signature (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.