2013 Medicare Part D Plan Formulary Information |
IU Health Plans Medicare Select Plus (HMO) (H7220-003-0)
Benefit Details
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The IU Health Plans Medicare Select Plus (HMO) (H7220-003-0) Formulary Drugs Starting with the Letter V in RANDOLPH County, IN: CMS MA Region 13 which includes: IN
|
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VAGIFEM 10 MCG VAGINAL TAB ![Compare how all Medicare Part D PDP plans in IN cover VAGIFEM 10 MCG VAGINAL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VALACYCLOVIR 1000 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in IN cover VALACYCLOVIR 1000 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALACYCLOVIR 500 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in IN cover VALACYCLOVIR 500 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALCYTE 450MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VALCYTE 450MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VALCYTE FOR ORAL SOLUTION 50MG/ML ![Compare how all Medicare Part D PDP plans in IN cover VALCYTE FOR ORAL SOLUTION 50MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Valproate Sodium 100mg/mL 10 VIAL, SINGLE-DOSE in 1 BOX / 5 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in IN cover Valproate Sodium 100mg/mL 10 VIAL, SINGLE-DOSE in 1 BOX / 5 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Valproic 250mg/1 100 CAPSULE, LIQUID FILLED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Valproic 250mg/1 100 CAPSULE, LIQUID FILLED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Valproic Acid 250mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Valproic Acid 250mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALSARTAN-HCTZ 160-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover VALSARTAN-HCTZ 160-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALSARTAN-HCTZ 160-25 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover VALSARTAN-HCTZ 160-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VALSARTAN-HCTZ 320-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover VALSARTAN-HCTZ 320-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALSARTAN-HCTZ 320-25 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover VALSARTAN-HCTZ 320-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALSARTAN-HCTZ 80-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover VALSARTAN-HCTZ 80-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VALTREX 1GM CAPLET (90 CT) ![Compare how all Medicare Part D PDP plans in IN cover VALTREX 1GM CAPLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VALTREX 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VALTREX 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VANCOCIN HCL 125MG PULVULE ![Compare how all Medicare Part D PDP plans in IN cover VANCOCIN HCL 125MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VANCOCIN HCL 250MG PULVULE ![Compare how all Medicare Part D PDP plans in IN cover VANCOCIN HCL 250MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VANCOMYCIN HCL 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover VANCOMYCIN HCL 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
VANCOMYCIN HCL 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover VANCOMYCIN HCL 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ) ![Compare how all Medicare Part D PDP plans in IN cover VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA ![Compare how all Medicare Part D PDP plans in IN cover Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE) ![Compare how all Medicare Part D PDP plans in IN cover VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | P |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in IN cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VANOS 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover VANOS 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VAQTA 25 UNITS/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover VAQTA 25 UNITS/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in IN cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VASERETIC 10-25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VASERETIC 10-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VASOTEC 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VASOTEC 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VASOTEC 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VASOTEC 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VASOTEC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VASOTEC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VASOTEC 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VASOTEC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
Vectibix 100mg/5mL 1 VIAL, SINGLE-USE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in IN cover Vectibix 100mg/5mL 1 VIAL, SINGLE-USE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VELCADE 3.5MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover VELCADE 3.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in IN cover Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL 37.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL 37.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HCL ER TAB 225 MG ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HCL ER TAB 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Ventavis 0.01mg/mL ![Compare how all Medicare Part D PDP plans in IN cover Ventavis 0.01mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
Ventavis 0.02mg/mL ![Compare how all Medicare Part D PDP plans in IN cover Ventavis 0.02mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in IN cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAPAMIL ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL ER 180 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL ER 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VERAPAMIL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VERAPAMIL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VERELAN 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VERELAN 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VERELAN 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERELAN 360MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN 360MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VERELAN PM 100MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN PM 100MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VERELAN PM 200MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN PM 200MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VERELAN PM 300MG CAP PELLET ![Compare how all Medicare Part D PDP plans in IN cover VERELAN PM 300MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VESICARE 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VESICARE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VESICARE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IN cover VESICARE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VFEND 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VFEND 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VFEND 40MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in IN cover VFEND 40MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VFEND 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VFEND 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VFEND IV 200MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover VFEND IV 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIBRAMYCIN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover VIBRAMYCIN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VICOPROFEN 200/7.5 TABLET ![Compare how all Medicare Part D PDP plans in IN cover VICOPROFEN 200/7.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU ![Compare how all Medicare Part D PDP plans in IN cover VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VIDEX 2GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in IN cover VIDEX 2GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IN cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIDEX EC 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IN cover VIDEX EC 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIDEX EC 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IN cover VIDEX EC 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIDEX EC 400MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IN cover VIDEX EC 400MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL] ![Compare how all Medicare Part D PDP plans in IN cover VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIGABATRIN 500 MG ORAL TABLET [SABRIL] ![Compare how all Medicare Part D PDP plans in IN cover VIGABATRIN 500 MG ORAL TABLET [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover VIGAMOX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIIBRYD 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in IN cover VIIBRYD 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIMPAT 10 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover VIMPAT 10 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in IN cover Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VINBLASTINE SULF 10MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover VINBLASTINE SULF 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
VINCRISTINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover VINCRISTINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
VINORELBINE 10MG/ML VIAL 5ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover VINORELBINE 10MG/ML VIAL 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | P |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIRAMUNE 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIRAMUNE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in IN cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIRAMUNE XR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIRAMUNE XR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIREAD 150 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIREAD 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIREAD 200 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIREAD 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIREAD 250 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIREAD 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIREAD 300MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIREAD 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIREAD POWDER ![Compare how all Medicare Part D PDP plans in IN cover VIREAD POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VIROPTIC 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover VIROPTIC 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VIVACTIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIVACTIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VIVACTIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VIVACTIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in IN cover Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in IN cover Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P ![Compare how all Medicare Part D PDP plans in IN cover Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA ![Compare how all Medicare Part D PDP plans in IN cover Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in IN cover VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VOLTAREN 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover VOLTAREN 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VOLTAREN-XR 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IN cover VOLTAREN-XR 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VORAXAZE 1,000 UNIT VIAL ![Compare how all Medicare Part D PDP plans in IN cover VORAXAZE 1,000 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VORICONAZOLE 200 MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover VORICONAZOLE 200 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Voriconazole 200mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Voriconazole 200mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
Voriconazole 50mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Voriconazole 50mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$7.00 | $21.00 | None |
VOSPIRE ER 4 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VOSPIRE ER 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VOSPIRE ER 8 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover VOSPIRE ER 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$85.00 | $255.00 | P |
VOTRIENT 200mg/1 120 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover VOTRIENT 200mg/1 120 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VPRIV INJECTION SOLUTION 2.5 MG/ML ![Compare how all Medicare Part D PDP plans in IN cover VPRIV INJECTION SOLUTION 2.5 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
VYTORIN 10/10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover VYTORIN 10/10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VYTORIN 10/20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover VYTORIN 10/20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VYTORIN 10/40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover VYTORIN 10/40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |
VYTORIN 10/80MG TABLET 2500 BOT ![Compare how all Medicare Part D PDP plans in IN cover VYTORIN 10/80MG TABLET 2500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$40.00 | $120.00 | None |