2013 Medicare Part D Plan Formulary Information |
MedicareRx Rewards Standard (PDP) (S5960-137-0)
Benefit Details
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The MedicareRx Rewards Standard (PDP) (S5960-137-0) Formulary Drugs Starting with the Letter P in CMS PDP Region 31 which includes: ID UT
|
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PACERONE 200MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PACERONE 400MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD ![Compare how all Medicare Part D PDP plans in UT cover PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PALGIC 4MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in UT cover PALGIC 4MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PALGIC TABLETS 4GM 100 CTR ![Compare how all Medicare Part D PDP plans in UT cover PALGIC TABLETS 4GM 100 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PAMIDRONATE 60MG/10ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PAMIDRONATE 60MG/10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in UT cover PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PANRETIN 0.1% GEL 60GM TUBE ![Compare how all Medicare Part D PDP plans in UT cover PANRETIN 0.1% GEL 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Pantoprazole 40mg/1 90 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Pantoprazole 40mg/1 90 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in UT cover PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
pantoprazole sodium 40 mg vial ![Compare how all Medicare Part D PDP plans in UT cover pantoprazole sodium 40 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PAROMOMYCIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PAROMOMYCIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Paroxetine 40mg/1 500 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Paroxetine 40mg/1 500 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:60 /30Days |
PAROXETINE FILM COATED 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE FILM COATED 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:90 /30Days |
PAROXETINE HCL TABLET 24 12.5MG ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL TABLET 24 12.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:180 /30Days |
PAROXETINE HCL TABLET 24 25MG ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL TABLET 24 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:90 /30Days |
Paroxetine Hydrochloride 37.5mg/1 30 BOTTLE in 1 BOTTLE / 30 TABLET, FILM COATED, EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in UT cover Paroxetine Hydrochloride 37.5mg/1 30 BOTTLE in 1 BOTTLE / 30 TABLET, FILM COATED, EXTENDED RELEASE .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:60 /30Days |
PAROXETINE HYDROCHLORIDE TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HYDROCHLORIDE TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:180 /30Days |
PAROXETINE TABLETS 30MG 90 BOT ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE TABLETS 30MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PASER GRANULES 4GM PACKET ![Compare how all Medicare Part D PDP plans in UT cover PASER GRANULES 4GM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
PAXIL ORAL SUSPENSION 10 MG/5ML ![Compare how all Medicare Part D PDP plans in UT cover PAXIL ORAL SUSPENSION 10 MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:1200 /30Days |
PEDI-DRI TOPICAL POWDER ![Compare how all Medicare Part D PDP plans in UT cover PEDI-DRI TOPICAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PEDVAXHIB VACCINE VIAL ![Compare how all Medicare Part D PDP plans in UT cover PEDVAXHIB VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PEGANONE 250MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PEGANONE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
PEGASYS 180MCG/0.5ML CONV.PK ![Compare how all Medicare Part D PDP plans in UT cover PEGASYS 180MCG/0.5ML CONV.PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PEGASYS INJECTION ![Compare how all Medicare Part D PDP plans in UT cover PEGASYS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PEGASYS PROCLICK 135 MCG/0.5 ![Compare how all Medicare Part D PDP plans in UT cover PEGASYS PROCLICK 135 MCG/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PEGINTRON 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in UT cover PEGINTRON 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PegIntron 120ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in UT cover PegIntron 120ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PegIntron 150ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in UT cover PegIntron 150ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PegIntron 50ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in UT cover PegIntron 50ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PegIntron 80ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in UT cover PegIntron 80ug/0.5mL 1 CARTRIDGE in 1 CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PENICILLIN G POTASSIUM FOR INJECTION 5000000UNIT/VIAL ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN G POTASSIUM FOR INJECTION 5000000UNIT/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PENICILLIN G PROCAINE 1200000UNT 2ML CTG ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN G PROCAINE 1200000UNT 2ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Penicillin G Sodium 5000000[iU]/1 10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in UT cover Penicillin G Sodium 5000000[iU]/1 10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Penicillin V Potassium 125mg/5mL 200 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Penicillin V Potassium 125mg/5mL 200 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Penicillin V Potassium 250mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Penicillin V Potassium 250mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN V POTASSIUM 250MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PENICILLIN V POTASSIUM 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN V POTASSIUM 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENTAM 300 INJ 300MG ![Compare how all Medicare Part D PDP plans in UT cover PENTAM 300 INJ 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PENTASA 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover PENTASA 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PENTASA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PENTASA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PENTAZOCINE/ACETAMIN TABLET ![Compare how all Medicare Part D PDP plans in UT cover PENTAZOCINE/ACETAMIN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:180 /30Days |
PENTOXIFYLLINE 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in UT cover PENTOXIFYLLINE 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERFOROMIST 20MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in UT cover PERFOROMIST 20MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:120 /30Days |
Perindopril Erbumine 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Perindopril Erbumine 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Perindopril Erbumine 4mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Perindopril Erbumine 4mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Perindopril Erbumine 8mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Perindopril Erbumine 8mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERIOGARD 0.12% ORAL RINSE ![Compare how all Medicare Part D PDP plans in UT cover PERIOGARD 0.12% ORAL RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERJETA 420 MG/14 ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PERJETA 420 MG/14 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Permethrin 50mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in UT cover Permethrin 50mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Perphenazine 16mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Perphenazine 16mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERPHENAZINE TABLETS 4MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE TABLETS 4MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERPHENAZINE TABLETS 8MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE TABLETS 8MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PERPHENAZINE TABLETS USP 2MG 100 BOT ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE TABLETS USP 2MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PFIZERPEN 20MMU VIAL ![Compare how all Medicare Part D PDP plans in UT cover PFIZERPEN 20MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Phenobarbital 100mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:120 /30Days |
Phenobarbital 15mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:800 /30Days |
PHENOBARBITAL 16.2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 16.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:741 /30Days |
PHENOBARBITAL 20 MG/5 ML ELIX ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 20 MG/5 ML ELIX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:3000 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Phenobarbital 30mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 30mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:400 /30Days |
PHENOBARBITAL 32.4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 32.4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:370 /30Days |
Phenobarbital 60mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:200 /30Days |
PHENOBARBITAL 64.8 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 64.8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:185 /30Days |
PHENOBARBITAL 97.2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 97.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:123 /30Days |
phenytoin 50 mg tablet chew ![Compare how all Medicare Part D PDP plans in UT cover phenytoin 50 mg tablet chew.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PHENYTOIN SOD EXT 200 MG CAP ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SOD EXT 200 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PHENYTOIN SODIUM 50mg/mL 25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SODIUM 50mg/mL 25 VIAL, SINGLE-DOSE in 1 CARTON / 2 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PHYSIOLYTE SOLUTION FOR IRRIGATION ![Compare how all Medicare Part D PDP plans in UT cover PHYSIOLYTE SOLUTION FOR IRRIGATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHYSIOSOL IRRIGATION SOL ![Compare how all Medicare Part D PDP plans in UT cover PHYSIOSOL IRRIGATION SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PILOCARPINE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Pilocarpine Hydrochloride 7.5mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Pilocarpine Hydrochloride 7.5mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PILOPINE HS 4% EYE GEL ![Compare how all Medicare Part D PDP plans in UT cover PILOPINE HS 4% EYE GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
pioglitaz-glimepir 30-2 mg tab ![Compare how all Medicare Part D PDP plans in UT cover pioglitaz-glimepir 30-2 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:30 /30Days |
pioglitaz-glimepir 30-4 mg tab ![Compare how all Medicare Part D PDP plans in UT cover pioglitaz-glimepir 30-4 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:30 /30Days |
pioglitazone hcl 15 mg tablet ![Compare how all Medicare Part D PDP plans in UT cover pioglitazone hcl 15 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:90 /30Days |
pioglitazone hcl 30 mg tablet ![Compare how all Medicare Part D PDP plans in UT cover pioglitazone hcl 30 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:45 /30Days |
pioglitazone hcl 45 mg tablet ![Compare how all Medicare Part D PDP plans in UT cover pioglitazone hcl 45 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
PIOGLITAZONE-METFORMIN 15-500 ![Compare how all Medicare Part D PDP plans in UT cover PIOGLITAZONE-METFORMIN 15-500.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:90 /30Days |
PIOGLITAZONE-METFORMIN 15-850 ![Compare how all Medicare Part D PDP plans in UT cover PIOGLITAZONE-METFORMIN 15-850.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIPERACILLIN 200 MG/ML / TAZOBACTAM 25 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PIPERACILLIN 200 MG/ML / TAZOBACTAM 25 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Piperacillin and Tazobactam 4; 0.5g/1; g/1 10 VIAL, SINGLE-USE in 1 CARTON / 1 INJECTION, POWDER, L ![Compare how all Medicare Part D PDP plans in UT cover Piperacillin and Tazobactam 4; 0.5g/1; g/1 10 VIAL, SINGLE-USE in 1 CARTON / 1 INJECTION, POWDER, L.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PIROXICAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PIROXICAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Piroxicam 20mg/1 500 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Piroxicam 20mg/1 500 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PLASMA-LYTE 148 IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PLASMA-LYTE 148 IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PLASMA-LYTE 56/DEXTROSE 5% ![Compare how all Medicare Part D PDP plans in UT cover PLASMA-LYTE 56/DEXTROSE 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML; ![Compare how all Medicare Part D PDP plans in UT cover PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PLAVIX 75MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PLAVIX 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:30 /30Days |
PLAVIX TABLETS 300MG ![Compare how all Medicare Part D PDP plans in UT cover PLAVIX TABLETS 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
PODOFILOX 0.5% TOPICAL TUBEX ![Compare how all Medicare Part D PDP plans in UT cover PODOFILOX 0.5% TOPICAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT) ![Compare how all Medicare Part D PDP plans in UT cover POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.00497 MEQ/ML / SODIUM BICARBONATE 1.43 MG/ ![Compare how all Medicare Part D PDP plans in UT cover POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.00497 MEQ/ML / SODIUM BICARBONATE 1.43 MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1% ![Compare how all Medicare Part D PDP plans in UT cover POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
POLYMYXIN B SULFATE VIAL ![Compare how all Medicare Part D PDP plans in UT cover POLYMYXIN B SULFATE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POMALYST 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
POMALYST 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
POMALYST 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
POMALYST 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PORTIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in UT cover PORTIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.45% ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.45%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CHLORIDE 10MEQ/100ML SOL ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 10MEQ/100ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 10MEQ/50ML SOL ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 10MEQ/50ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 149mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 149mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 5 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride 20.000000meq/1 ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride 20.000000meq/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225% ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 20MEQ/50ML SOL ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 20MEQ/50ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 30MEQ/100ML SOL ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 30MEQ/100ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE ER CAPSULES 10MEQ ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE ER CAPSULES 10MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
POTASSIUM CHLORIDE ER CPCR 8MEQ ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE ER CPCR 8MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
POTASSIUM CHLORIDE EXTENDED RELEASE TABLETS ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE EXTENDED RELEASE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE IN DEXTROSE 5; 0.3g/100mL; g/100mL 12 CONTAINER in 1 CASE / 1000 mL in 1 CONTAIN ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN DEXTROSE 5; 0.3g/100mL; g/100mL 12 CONTAINER in 1 CASE / 1000 mL in 1 CONTAIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride in Dextrose 5; 224g/100mL; mg/100mL 1000 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride in Dextrose 5; 224g/100mL; mg/100mL 1000 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.33g/100mL; g/100mL; g/100mL 12 CONTAI ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.33g/100mL; g/100mL; g/100mL 12 CONTAI.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Potassium Chloride in Lactated Ringers and Dextrose 20; 5; 179; 600; 310mg/100mL; g/100mL; mg/100mL ![Compare how all Medicare Part D PDP plans in UT cover Potassium Chloride in Lactated Ringers and Dextrose 20; 5; 179; 600; 310mg/100mL; g/100mL; mg/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION 0.15%-0.9% 12 X 1000ML BAG ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION 0.15%-0.9% 12 X 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CITRATE ER 10 MEQ TB ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CITRATE ER 10 MEQ TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
POTASSIUM CITRATE ER 5 MEQ TAB ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CITRATE ER 5 MEQ TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
POTIGA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover POTIGA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:90 /30Days |
POTIGA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover POTIGA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:90 /30Days |
POTIGA 400 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover POTIGA 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:90 /30Days |
POTIGA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover POTIGA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:270 /30Days |
PRADAXA 150mg/1 1 BOTTLE in 1 CARTON / 60 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover PRADAXA 150mg/1 1 BOTTLE in 1 CARTON / 60 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:60 /30Days |
PRADAXA 75mg/1 1 BOTTLE in 1 CARTON / 60 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover PRADAXA 75mg/1 1 BOTTLE in 1 CARTON / 60 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:60 /30Days |
Pramipexole Dihydrochloride 0.125mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pramipexole Dihydrochloride 0.125mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Pramipexole Dihydrochloride 0.25mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pramipexole Dihydrochloride 0.25mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Pramipexole Dihydrochloride 0.5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pramipexole Dihydrochloride 0.5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Pramipexole Dihydrochloride 1.5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pramipexole Dihydrochloride 1.5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Pramipexole Dihydrochloride 1mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pramipexole Dihydrochloride 1mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PRAMIPEXOLE DIHYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE DIHYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PRAVASTATIN SODIUM 20MG TABLET 500 BOT ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 20MG TABLET 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
PRAVASTATIN SODIUM 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
Pravastatin Sodium 80 mg tab ![Compare how all Medicare Part D PDP plans in UT cover Pravastatin Sodium 80 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
PRAVASTATIN SODIUM TABLETS 10MG 90 BOT ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM TABLETS 10MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | Q:30 /30Days |
PRAZOSIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PRAZOSIN HCL 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN HCL 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PRAZOSIN HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNICARBATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover PREDNICARBATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNICARBATE 1 MG/ML TOPICAL CREAM ![Compare how all Medicare Part D PDP plans in UT cover PREDNICARBATE 1 MG/ML TOPICAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREDNISOLONE SOD 1% EYE DROP ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE SOD 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREDNISONE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISONE 5MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PREDNISONE 5MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PREMARIN 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | S |
PREMARIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | S |
PREMARIN 0.625MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.625MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | S |
Premarin 0.625mg/g ![Compare how all Medicare Part D PDP plans in UT cover Premarin 0.625mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
PREMARIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | S |
PREMARIN 1.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 1.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | S |
PREMASOL 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREMASOL 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PREMASOL 6% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREMASOL 6% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PREVALITE POW 4GM ![Compare how all Medicare Part D PDP plans in UT cover PREVALITE POW 4GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Previfem 6 BLISTER PACK in 1 BLISTER PACK / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in UT cover Previfem 6 BLISTER PACK in 1 BLISTER PACK / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PREZISTA 100 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA 100 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PREZISTA 800 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PREZISTA TABLET 600MG ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLET 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PREZISTA TABLET 75MG ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLET 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None |
PREZISTA TABLETS ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PREZISTA TABLETS 400MG 60 TABLETS BOT ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLETS 400MG 60 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PRIFTIN 150MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRIFTIN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PRIMAQUINE 26.3MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRIMAQUINE 26.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PRIMAXIN IV 250MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover PRIMAXIN IV 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS ![Compare how all Medicare Part D PDP plans in UT cover PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Primidone 250mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Primidone 250mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Primidone 50mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Primidone 50mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PRISTIQ 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in UT cover PRISTIQ 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:120 /30Days |
Pristiq Extended-Release 50mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Pristiq Extended-Release 50mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | P Q:240 /30Days |
PRIVIGEN 10% VIAL ![Compare how all Medicare Part D PDP plans in UT cover PRIVIGEN 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PROAIR HFA 90 MCG INHALER ![Compare how all Medicare Part D PDP plans in UT cover PROAIR HFA 90 MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:27 /30Days |
PROBENECID 500MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROBENECID 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROBENECID/COLCHICINE TABLET S ![Compare how all Medicare Part D PDP plans in UT cover PROBENECID/COLCHICINE TABLET S.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROCAINAMIDE 100MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCAINAMIDE 100MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PROCAINAMIDE 500MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCAINAMIDE 500MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0 ![Compare how all Medicare Part D PDP plans in UT cover ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROCRIT 10000U/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 10000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 2000U/ML VIAL 6 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PROCRIT 3000U/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 3000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PROCRIT 40000U/ML VIAL PR ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 40000U/ML VIAL PR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PROCRIT 4000U/ML VIAL 25 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 4000U/ML VIAL 25 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
procto-pak 1% cream ![Compare how all Medicare Part D PDP plans in UT cover procto-pak 1% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
proctozone-hc 2.5% cream ![Compare how all Medicare Part D PDP plans in UT cover proctozone-hc 2.5% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROGESTERONE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROGESTERONE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROGESTERONE 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROGESTERONE 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Proglycem 50mg/mL 1 BOTTLE, DROPPER in 1 BOX / 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in UT cover Proglycem 50mg/mL 1 BOTTLE, DROPPER in 1 BOX / 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
PROGRAF 5MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in UT cover PROGRAF 5MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P |
PROLASTIN-C 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in UT cover PROLASTIN-C 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PROLEUKIN 22 MILLION UNIT VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROLEUKIN 22 MILLION UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | None |
PROLIA INJECTION ![Compare how all Medicare Part D PDP plans in UT cover PROLIA INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | P Q:2 /365Days |
PROMACTA 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PROMACTA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
PROMACTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMACTA 75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
Propafenone HCl 150mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Propafenone HCl 150mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROPAFENONE HCL 225MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL 225MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROPAFENONE HCL 300MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL 300MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in UT cover Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROPARACAINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover PROPARACAINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
Propranolol 1mg/mL 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in UT cover Propranolol 1mg/mL 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PROPRANOLOL 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL 60MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL HCL 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL HCL 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL HCL TABLET USP 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL HCL TABLET USP 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL HCL TABLET USP 40MG (1000 CT) ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL HCL TABLET USP 40MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Propranolol Hydrochloride 120mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Propranolol Hydrochloride 120mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Propranolol Hydrochloride 160mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Propranolol Hydrochloride 160mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Propranolol Hydrochloride 60mg/1 1000 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Propranolol Hydrochloride 60mg/1 1000 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
Propranolol Hydrochloride 80mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Propranolol Hydrochloride 80mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROPRANOLOL/HCTZ 40/25 TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL/HCTZ 40/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROPRANOLOL/HCTZ 80/25 TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL/HCTZ 80/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROPYLTHIOURACIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPYLTHIOURACIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $3.00 | None |
PROQUAD VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROQUAD VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROSOL 20% INJECTION ![Compare how all Medicare Part D PDP plans in UT cover PROSOL 20% INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
Protonix I.V. 40mg/10mL 10 CARTON in 1 PACKAGE / 1 VIAL in 1 CARTON / 40 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in UT cover Protonix I.V. 40mg/10mL 10 CARTON in 1 PACKAGE / 1 VIAL in 1 CARTON / 40 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Injectable Drugs |
25% | 25% | None |
PROTRIPTYLINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in UT cover PROTRIPTYLINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG ![Compare how all Medicare Part D PDP plans in UT cover PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |
PULMOZYME 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in UT cover PULMOZYME 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Specialty Tier |
25% | N/A | P |
pyridostigmine br 60 mg tablet ![Compare how all Medicare Part D PDP plans in UT cover pyridostigmine br 60 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $10.50 | None |