2013 Medicare Part D Plan Formulary Information |
United American - Select (PDP) (S5755-086-0)
Benefit Details
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The United American - Select (PDP) (S5755-086-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 15 which includes: IN KY
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in IN cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:6 /90Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SANDIMMUNE 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover SANDIMMUNE 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in IN cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SAPHRIS 10mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in IN cover SAPHRIS 10mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SAPHRIS 5mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in IN cover SAPHRIS 5mg/1 6 CASE in 1 CARTON / 1 BLISTER PACK in 1 CASE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in IN cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:180 /90Days |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:360 /90Days |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in IN cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:180 /90Days |
SEROMYCIN 250mg/250mg 40 CAPSULE in 1 BOTTLE / 250 mg in 1 CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SEROMYCIN 250mg/250mg 40 CAPSULE in 1 BOTTLE / 250 mg in 1 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:270 /90Days |
SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in IN cover SERTRALINE HYDROCHLORIDE ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in IN cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in IN cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Signifor .3 mg/mL ![Compare how all Medicare Part D PDP plans in IN cover Signifor .3 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Signifor .6 mg/mL ![Compare how all Medicare Part D PDP plans in IN cover Signifor .6 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P |
Signifor .9 mg/mL ![Compare how all Medicare Part D PDP plans in IN cover Signifor .9 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P |
SILDENAFIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SILDENAFIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | P Q:270 /90Days |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in IN cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in IN cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:1 /30Days |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:90 /90Days |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:90 /90Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:90 /90Days |
SIMVASTATIN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:90 /90Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in IN cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SINGULAIR 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:90 /90Days |
SINGULAIR 4 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 4 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:90 /90Days |
SINGULAIR 4MG GRANULES ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 4MG GRANULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:90 /90Days |
SINGULAIR 5 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IN cover SINGULAIR 5 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:90 /90Days |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | None |
SKELID 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SKELID 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | P Q:180 /90Days |
SKLICE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in IN cover SKLICE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sodium Chloride 3g/100mL ![Compare how all Medicare Part D PDP plans in IN cover Sodium Chloride 3g/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in IN cover Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SODIUM PHENYLBUTYRATE POWDER ![Compare how all Medicare Part D PDP plans in IN cover SODIUM PHENYLBUTYRATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
sodium polystyrene sulf pwd ![Compare how all Medicare Part D PDP plans in IN cover sodium polystyrene sulf pwd.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SOLARAZE 3% GEL ![Compare how all Medicare Part D PDP plans in IN cover SOLARAZE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SOLTAMOX 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in IN cover SOLTAMOX 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SOLU CORTEF INJECTION ![Compare how all Medicare Part D PDP plans in IN cover SOLU CORTEF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SOLU CORTEF INJECTION 100 MG/VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU CORTEF INJECTION 100 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SOLU MEDROL FOR INJECTION 40 MG/ML ![Compare how all Medicare Part D PDP plans in IN cover SOLU MEDROL FOR INJECTION 40 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SOLU MEDROL FOR INJECTION 500 MG/ML ![Compare how all Medicare Part D PDP plans in IN cover SOLU MEDROL FOR INJECTION 500 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Solu-Medrol 125mg/mL 25 VIAL, PATENT DELIVERY SYSTEM in 1 PACKAGE / 2 mL in 1 VIAL, PATENT DELIVERY ![Compare how all Medicare Part D PDP plans in IN cover Solu-Medrol 125mg/mL 25 VIAL, PATENT DELIVERY SYSTEM in 1 PACKAGE / 2 mL in 1 VIAL, PATENT DELIVERY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOLU-MEDROL 2000MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOLU-MEDROL 2000MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in IN cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | None |
Somatuline Depot 90mg/0.3mL 1 POUCH in 1 CARTON / 1 SYRINGE in 1 POUCH / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IN cover Somatuline Depot 90mg/0.3mL 1 POUCH in 1 CARTON / 1 SYRINGE in 1 POUCH / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | None |
SOMAVERT 10MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 10MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SOMAVERT 15MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 15MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SOMAVERT 20MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover SOMAVERT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | P |
SORIATANE 17.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SORIATANE 17.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in IN cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SORIATANE CAPSULES ![Compare how all Medicare Part D PDP plans in IN cover SORIATANE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in IN cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
sotalol hydrochloride 160mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover sotalol hydrochloride 160mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in IN cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SPRYCEL 100mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 100mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:180 /90Days |
SPRYCEL 140mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 140mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:90 /90Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:180 /90Days |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:90 /90Days |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:90 /90Days |
SPRYCEL 80mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SPRYCEL 80mg/1 1 BOTTLE in 1 CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:90 /90Days |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in IN cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SSD Cream 10g/1000g 85 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IN cover SSD Cream 10g/1000g 85 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
STAGESIC 5MG-500MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STAGESIC 5MG-500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:720 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STALEVO 125/200 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 125/200 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STALEVO 18.75/75 MG/MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 18.75/75 MG/MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in IN cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STAVUDINE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:7200 /90Days |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in IN cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Stimate 1.5mg/mL 1 BOTTLE, SPRAY in 1 CARTON / 2.5 mL in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in IN cover Stimate 1.5mg/mL 1 BOTTLE, SPRAY in 1 CARTON / 2.5 mL in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:252 /90Days |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in IN cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in IN cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SUBOXONE 12 MG-3 MG SL FILM ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 12 MG-3 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Suboxone 2; 0.5mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in IN cover Suboxone 2; 0.5mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SUBOXONE 2MG-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 2MG-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SUBOXONE 4 MG-1 MG SL FILM ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 4 MG-1 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
Suboxone 8; 2mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in IN cover Suboxone 8; 2mg/1; mg/1 30 POUCH in 1 CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SUBOXONE 8MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUBOXONE 8MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in IN cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SULFADIAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULFADIAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE W/TMP 800-160MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$1.00 | $0.00 | None |
SULFAMYLON 50G PACKET ![Compare how all Medicare Part D PDP plans in IN cover SULFAMYLON 50G PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SULFAMYLON CREAM 85GM 4 OZ TUBE ![Compare how all Medicare Part D PDP plans in IN cover SULFAMYLON CREAM 85GM 4 OZ TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | None |
Sumatriptan 6 mg/0.5 ml vial ![Compare how all Medicare Part D PDP plans in IN cover Sumatriptan 6 mg/0.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:12 /90Days |
Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IN cover Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:12 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:27 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 25MG 9 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:54 /90Days |
SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX ![Compare how all Medicare Part D PDP plans in IN cover SUMATRIPTAN SUCCINATE TABLETS 50MG 9 (3 CARDS OF 3) BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$4.00 | $24.00 | Q:54 /90Days |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SUPRAX 400 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in IN cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:360 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:630 /90Days |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:90 /90Days |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:270 /90Days |
SUTENT 25mg/1 28 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 25mg/1 28 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:90 /90Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:90 /90Days |
SYLATRON 296 MCG KIT 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in IN cover SYLATRON 296 MCG KIT 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:12 /90Days |
SYLATRON 444 MCG KIT 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in IN cover SYLATRON 444 MCG KIT 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:12 /90Days |
SYLATRON 888 MCG KIT 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in IN cover SYLATRON 888 MCG KIT 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P Q:8 /90Days |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in IN cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:31 /90Days |
SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL ![Compare how all Medicare Part D PDP plans in IN cover SYMBICORT 80-4.5MCG HFA AEROSOL WITH ADAPTER 60 INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | Q:31 /90Days |
SYMBYAX 12-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 12-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMBYAX 12-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 12-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
Symbyax 25; 3mg/1; mg/1 30 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Symbyax 25; 3mg/1; mg/1 30 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
SYMBYAX 6-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 6-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
SYMBYAX 6-50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover SYMBYAX 6-50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:90 /90Days |
SYMLINPEN 120 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in IN cover SYMLINPEN 120 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:33 /90Days |
SYMLINPEN 60 1000MCG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in IN cover SYMLINPEN 60 1000MCG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | Q:33 /90Days |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IN cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Name Drugs |
$95.00 | $257.00 | None |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Drugs |
25% | 25% | P |
SYPRINE 250MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover SYPRINE 250MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Name Drugs |
$31.00 | $98.00 | None |