2013 Medicare Part D Plan Formulary Information |
Gateway Health Plan Medicare Assured Select (HMO SNP) (H5932-007-0)
Benefit Details
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The Gateway Health Plan Medicare Assured Select (HMO SNP) (H5932-007-0) Formulary Drugs Starting with the Letter M in ARMSTRONG County, PA: CMS MA Region 6 which includes: PA
|
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in PA cover M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
Macrodantin Nitrofurantion crystals 25mg 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Macrodantin Nitrofurantion crystals 25mg 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
MALARONE 250-100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MALARONE 250-100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MALARONE 62.5-25MG PED TABLET ![Compare how all Medicare Part D PDP plans in PA cover MALARONE 62.5-25MG PED TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Malathion 5mg/mL 1 BOTTLE in 1 CARTON / 59 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Malathion 5mg/mL 1 BOTTLE in 1 CARTON / 59 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MAPROTILINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MAPROTILINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MAPROTILINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MAPROTILINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MAPROTILINE 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MAPROTILINE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MARPLAN 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover MARPLAN 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MATULANE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MATULANE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Matzim LA 180mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Matzim LA 180mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Matzim LA 240mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Matzim LA 240mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Matzim LA 300mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Matzim LA 300mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Matzim LA 360mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Matzim LA 360mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Matzim LA 420mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Matzim LA 420mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MAXALT 10mg/1 18 POUCH in 1 CARTON / 1 TABLET in 1 POUCH ![Compare how all Medicare Part D PDP plans in PA cover MAXALT 10mg/1 18 POUCH in 1 CARTON / 1 TABLET in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:18 /30Days |
MAXALT 5mg/1 18 POUCH in 1 CARTON / 1 TABLET in 1 POUCH ![Compare how all Medicare Part D PDP plans in PA cover MAXALT 5mg/1 18 POUCH in 1 CARTON / 1 TABLET in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:18 /30Days |
MAXALT MLT 10MG TABLET 4X3 UNIT DOSE CASE ![Compare how all Medicare Part D PDP plans in PA cover MAXALT MLT 10MG TABLET 4X3 UNIT DOSE CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:18 /30Days |
MAXALT MLT 5MG TABLET 4X3 UNIT CASE ![Compare how all Medicare Part D PDP plans in PA cover MAXALT MLT 5MG TABLET 4X3 UNIT CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:18 /30Days |
MAXIDEX OPHTHALMIC SUSPENSION 0.1% 5ML BOT ![Compare how all Medicare Part D PDP plans in PA cover MAXIDEX OPHTHALMIC SUSPENSION 0.1% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN ![Compare how all Medicare Part D PDP plans in PA cover MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEFLOQUINE HCL 250MG TABLET 25 BOT ![Compare how all Medicare Part D PDP plans in PA cover MEFLOQUINE HCL 250MG TABLET 25 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEGESTROL 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MEGESTROL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MEGESTROL ACETATE 40MG TABLET (250 CT) ![Compare how all Medicare Part D PDP plans in PA cover MEGESTROL ACETATE 40MG TABLET (250 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Meloxicam 15mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Meloxicam 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MELOXICAM 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MELOXICAM 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MELOXICAM 7.5MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in PA cover MELOXICAM 7.5MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MELPHALAN 5 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover MELPHALAN 5 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL ![Compare how all Medicare Part D PDP plans in PA cover Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
MENEST 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MENEST 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MENEST 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MENEST 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MENEST 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MENEST 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MENEST 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MENEST 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MENOMUNE-A/C/Y/W-135 VIAL ![Compare how all Medicare Part D PDP plans in PA cover MENOMUNE-A/C/Y/W-135 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
MENVEO INJECTION KIT ![Compare how all Medicare Part D PDP plans in PA cover MENVEO INJECTION KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
MEPERIDINE 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover MEPERIDINE 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:1000 /30Days |
Meperidine Hydrochloride 100mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Meperidine Hydrochloride 100mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Meperidine Hydrochloride 25mg/mL 25 VIAL in 1 CARTON / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Meperidine Hydrochloride 25mg/mL 25 VIAL in 1 CARTON / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:180 /30Days |
Meperidine Hydrochloride 50mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Meperidine Hydrochloride 50mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:180 /30Days |
Meperidine Hydrochloride 50mg/mL 25 VIAL in 1 CARTON / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Meperidine Hydrochloride 50mg/mL 25 VIAL in 1 CARTON / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:180 /30Days |
MEPRON 750MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover MEPRON 750MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
MERCAPTOPURINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MERCAPTOPURINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEROPENEM FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover MEROPENEM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Mesalamine 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in PA cover Mesalamine 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MESNA INJECTION 1GM/ML 10ML VIALMD CRTN ![Compare how all Medicare Part D PDP plans in PA cover MESNA INJECTION 1GM/ML 10ML VIALMD CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P |
MESNEX 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MESNEX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MESTINON 180MG TIMESPAN ![Compare how all Medicare Part D PDP plans in PA cover MESTINON 180MG TIMESPAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MESTINON 60MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover MESTINON 60MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METAPROTERENOL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METAPROTERENOL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METAPROTERENOL 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METAPROTERENOL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METFORMIN HCL 1000MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover METFORMIN HCL 1000MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL 500MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover METFORMIN HCL 500MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL ER 1,000 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METFORMIN HCL ER 1,000 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL ER 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover METFORMIN HCL ER 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:120 /30Days |
Metformin Hydrochloride 750mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Metformin Hydrochloride 750mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:90 /30Days |
METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:90 /30Days |
METHADONE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover METHADONE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:300 /30Days |
METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:300 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHAZOLAMIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHAZOLAMIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METHAZOLAMIDE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHAZOLAMIDE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methenamine Hippurate 1g/1 ![Compare how all Medicare Part D PDP plans in PA cover Methenamine Hippurate 1g/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methimazole 10mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Methimazole 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METHIMAZOLE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover METHIMAZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Methocarbamol 500mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Methocarbamol 500mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | P |
METHOCARBAMOL 750MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover METHOCARBAMOL 750MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | P |
METHOTREXATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHOTREXATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P |
Methotrexate 25mg/mL 10 VIAL in 1 BOX, UNIT-DOSE / 8 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Methotrexate 25mg/mL 10 VIAL in 1 BOX, UNIT-DOSE / 8 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P |
METHOTREXATE FOR INJECTION 1 GM/ML ![Compare how all Medicare Part D PDP plans in PA cover METHOTREXATE FOR INJECTION 1 GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P |
METHSCOPOLAMINE BROMIDE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHSCOPOLAMINE BROMIDE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYCLOTHIAZIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYCLOTHIAZIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METHYLDOPA 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLDOPA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METHYLDOPA 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLDOPA 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Methyldopa and Hydrochlorothiazide 25; 250mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Methyldopa and Hydrochlorothiazide 25; 250mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METHYLDOPA/HCTZ 250-15 TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLDOPA/HCTZ 250-15 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METHYLPHENIDATE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:90 /30Days |
METHYLPHENIDATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:120 /30Days |
METHYLPHENIDATE ER 27 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE ER 27 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:30 /30Days |
METHYLPHENIDATE ER 36 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE ER 36 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:30 /30Days |
METHYLPHENIDATE ER 54 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE ER 54 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:30 /30Days |
METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 20mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 20mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | P Q:120 /30Days |
METHYLPREDNISOLONE 16MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLPREDNISOLONE 16MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METHYLPREDNISOLONE 32MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLPREDNISOLONE 32MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 5 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in PA cover Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 5 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methylprednisolone 4mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Methylprednisolone 4mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METHYLPREDNISOLONE 8 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover METHYLPREDNISOLONE 8 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS in 1 CARTON / 1 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in PA cover Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS in 1 CARTON / 1 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Methylprednisolone Sodium Succinate 1g/8mL 1 VIAL, SINGLE-DOSE in 1 BOX / 8 mL in 1 VIAL, SINGLE-DO ![Compare how all Medicare Part D PDP plans in PA cover Methylprednisolone Sodium Succinate 1g/8mL 1 VIAL, SINGLE-DOSE in 1 BOX / 8 mL in 1 VIAL, SINGLE-DO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Metoclopramide 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOCLOPRAMIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOCLOPRAMIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOCLOPRAMIDE SOLUTION ORAL USP 5MG 1 PT BOT ![Compare how all Medicare Part D PDP plans in PA cover METOCLOPRAMIDE SOLUTION ORAL USP 5MG 1 PT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOLAZONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOLAZONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOLAZONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOLAZONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOLAZONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOLAZONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL SUCC ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL SUCC ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL SUCC ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL SUCC ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL SUCCINATE 25MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL SUCCINATE 25MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL SUCINNATE TABLETS EXTENDED RELEASE 200MG 1000 BOT ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL SUCINNATE TABLETS EXTENDED RELEASE 200MG 1000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL TARTRATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL TARTRATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL TARTRATE TABLET USP 100MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL TARTRATE TABLET USP 100MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METROGEL TOPICAL 1% GEL ![Compare how all Medicare Part D PDP plans in PA cover METROGEL TOPICAL 1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE 0.75% CREAM ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE 0.75% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE 0.75% LOTION ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE 0.75% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Metronidazole 375mg/1 50 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Metronidazole 375mg/1 50 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METRONIDAZOLE TABLETS USP 250MG 250 BOTPL ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE TABLETS USP 250MG 250 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METRONIDAZOLE TABLETS USP 500MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE TABLETS USP 500MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METRONIDAZOLE VAGINAL GEL ![Compare how all Medicare Part D PDP plans in PA cover METRONIDAZOLE VAGINAL GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEXILETINE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MEXILETINE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEXILETINE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MEXILETINE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MEXILETINE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MEXILETINE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MICONAZOLE 3 200MG SUPPOS. ![Compare how all Medicare Part D PDP plans in PA cover MICONAZOLE 3 200MG SUPPOS..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MICROGESTIN FE 1.5/30 TABLET ![Compare how all Medicare Part D PDP plans in PA cover MICROGESTIN FE 1.5/30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MICROGESTIN FE 1/20 TABLET ![Compare how all Medicare Part D PDP plans in PA cover MICROGESTIN FE 1/20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MIDODRINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MIDODRINE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover MIDODRINE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIGERGOT 2-100MG SUPPOSITORY RECTAL ![Compare how all Medicare Part D PDP plans in PA cover MIGERGOT 2-100MG SUPPOSITORY RECTAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIGRANAL 0.5MG/SPRY AEROSOL SPRAY W/PUMP ![Compare how all Medicare Part D PDP plans in PA cover MIGRANAL 0.5MG/SPRY AEROSOL SPRAY W/PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:8 /30Days |
MILLIPRED TABLETS 5MG ![Compare how all Medicare Part D PDP plans in PA cover MILLIPRED TABLETS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MINOCYCLINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MINOCYCLINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MINOCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MINOCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MINOCYCLINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MINOCYCLINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Minocycline Hydrochloride 100mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Minocycline Hydrochloride 100mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MINOXIDIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MINOXIDIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MINOXIDIL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MINOXIDIL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIRTAZAPINE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MIRTAZAPINE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 15MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in PA cover MIRTAZAPINE 15MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 30MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in PA cover MIRTAZAPINE 30MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Mirtazapine 7.5mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Mirtazapine 7.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX ![Compare how all Medicare Part D PDP plans in PA cover MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MIRTAZAPINE TABLET 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover MIRTAZAPINE TABLET 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
misoprostol 200 mcg tablet ![Compare how all Medicare Part D PDP plans in PA cover misoprostol 200 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MITOXANTRONE INJECTION 2MG 125ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover MITOXANTRONE INJECTION 2MG 125ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MOMETASONE FUROATE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in PA cover MOMETASONE FUROATE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
Mometasone Furoate 1mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Mometasone Furoate 1mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MOMETASONE FUROATE OINTMENT 0.1% 45GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover MOMETASONE FUROATE OINTMENT 0.1% 45GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN ![Compare how all Medicare Part D PDP plans in PA cover MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MONTELUKAST SOD 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover MONTELUKAST SOD 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
montelukast sod 4 mg tab chew ![Compare how all Medicare Part D PDP plans in PA cover montelukast sod 4 mg tab chew.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:30 /30Days |
montelukast sod 5 mg tab chew ![Compare how all Medicare Part D PDP plans in PA cover montelukast sod 5 mg tab chew.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:30 /30Days |
MORPHINE SULFATE 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:90 /30Days |
Morphine Sulfate 100mg/5mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Morphine Sulfate 100mg/5mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:180 /30Days |
MORPHINE SULFATE 15MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE 15MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:180 /30Days |
MORPHINE SULFATE 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:90 /30Days |
MORPHINE SULFATE 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:180 /30Days |
MORPHINE SULFATE ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:1000 /30Days |
MORPHINE SULFATE ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:1000 /30Days |
MORPHINE SULFATE TABLET ER 60MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE TABLET ER 60MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:90 /30Days |
MORPHINE SULFATE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULFATE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover MORPHINE SULFATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:180 /30Days |
MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
MOZOBIL SOLUTION 24MG/1.2ML ![Compare how all Medicare Part D PDP plans in PA cover MOZOBIL SOLUTION 24MG/1.2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:10 /30Days |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MUPIROCIN 2% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover MUPIROCIN 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None |
MYCOBUTIN 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover MYCOBUTIN 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |