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2013 Medicare Part D Plan Formulary Information
Reader''s Digest Value Rx (PDP) (S0128-007-0) Benefit Details
The Reader''s Digest Value Rx (PDP) (S0128-007-0) Formulary Drugs Starting with the Letter N in CMS PDP Region 6 which includes: PA WV
Drugs Starting with Letter N Drug Name	Drug Tier Information		Cost-Sharing		Drug Usage Mgmt
Drugs Starting with Letter N Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NABUMETONE 500MG TABLET	3	Preferred Brand	$35.00	$105.00	None
NABUMETONE 750MG TABLET	3	Preferred Brand	$35.00	$105.00	None
NADOLOL 20MG TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NADOLOL TABLETS	2	Non-preferred Generic	$2.50	$7.50	None
NADOLOL TABLETS	2	Non-preferred Generic	$2.50	$7.50	None
NADOLOL-BENDROFLU 40-5 MG TAB	3	Preferred Brand	$35.00	$105.00	None
NADOLOL-BENDROFLU 80-5 MG TAB	3	Preferred Brand	$35.00	$105.00	None
Nafcillin 10g/100mL	3	Preferred Brand	$35.00	$105.00	None
NAFCILLIN 1GM/50ML INJ	4	Non-preferred Brand	27%	27%	None
NAFCILLIN FOR INJECTION 1 GM/ML	3	Preferred Brand	$35.00	$105.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NAGLAZYME 5MG/5ML VIAL	4	Non-preferred Brand	27%	27%	P Q:480 /28Days
Nalbuphine Hydrochloride 10mg/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE	3	Preferred Brand	$35.00	$105.00	None
Nalbuphine Hydrochloride 20mg/mL 25 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE	3	Preferred Brand	$35.00	$105.00	None
NALFON 200MG CAPSULE	4	Non-preferred Brand	27%	27%	None
Nalfon 400mg/1 90 CAPSULE in 1 BOTTLE, PLASTIC	4	Non-preferred Brand	27%	27%	None
naloxone 1 mg/ml syringe	2	Non-preferred Generic	$2.50	$7.50	None
NALTREXONE HCL 50MG TABLET 100 BLPK	2	Non-preferred Generic	$2.50	$7.50	None
NAMENDA 10MG TABLET	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NAMENDA 10MG/5ML SOLUTION	3	Preferred Brand	$35.00	$105.00	Q:360 /30Days
NAMENDA 5-10MG TITRATION PK	3	Preferred Brand	$35.00	$105.00	Q:98 /30Days
NAMENDA 5MG TABLET	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NAMENDA XR 14 MG CAPSULE	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NAMENDA XR 21 MG CAPSULE	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NAMENDA XR 28 MG CAPSULE	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NAMENDA XR 7 MG CAPSULE	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NAMENDA XR TITRATION PACK	3	Preferred Brand	$35.00	$105.00	Q:28 /28Days
NAPROXEN 125MG/5ML SUSPEN	2	Non-preferred Generic	$2.50	$7.50	None
NAPROXEN 250 MG ORAL TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NAPROXEN 375MG TABLET EC	2	Non-preferred Generic	$2.50	$7.50	None
NAPROXEN 500MG TABLET EC	2	Non-preferred Generic	$2.50	$7.50	None
Naproxen 500mg/1 500 TABLET BOTTLE	2	Non-preferred Generic	$2.50	$7.50	None
NAPROXEN SODIUM 275 MG ORAL TABLET	2	Non-preferred Generic	$2.50	$7.50	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
Naproxen Sodium 550mg/1	2	Non-preferred Generic	$2.50	$7.50	None
NAPROXEN TABLET 375MG (500 CT)	2	Non-preferred Generic	$2.50	$7.50	None
NARATRIPTAN TABLETS	3	Preferred Brand	$35.00	$105.00	Q:9 /30Days
NARATRIPTAN TABLETS	3	Preferred Brand	$35.00	$105.00	Q:9 /30Days
NARDIL 15MG TABLET	4	Non-preferred Brand	27%	27%	None
NASONEX 50ug/1 120 SPRAY, METERED in 1 BOTTLE, PUMP	3	Preferred Brand	$35.00	$105.00	Q:34 /30Days
NATACYN EYE DROPS	4	Non-preferred Brand	27%	27%	None
Nateglinide 120mg/1 90 TABLET BOTTLE	3	Preferred Brand	$35.00	$105.00	None
Nateglinide 60mg/1 90 TABLET BOTTLE	3	Preferred Brand	$35.00	$105.00	None
NECON 0.5/35-28 TABLET	4	Non-preferred Brand	27%	27%	None
NECON 1/35-28 TABLET	4	Non-preferred Brand	27%	27%	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NECON 10/11-28 TABLET	4	Non-preferred Brand	27%	27%	None
NEFAZODONE HCL 150MG TABLET (60 CT)	2	Non-preferred Generic	$2.50	$7.50	None
NEFAZODONE HCL 250MG TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NEFAZODONE HCL 50MG TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT	2	Non-preferred Generic	$2.50	$7.50	None
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT	2	Non-preferred Generic	$2.50	$7.50	None
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT	2	Non-preferred Generic	$2.50	$7.50	None
Neomycin and Polymyxin B Sulfates 40; 200000mg/mL; 1/mL 10 AMPULE in 1 CARTON / 1 mL in 1 AMPULE	3	Preferred Brand	$35.00	$105.00	None
Neomycin and Polymyxin B Sulfates and Dexamethasone 1; 3.5; 10000mg/g; mg/g; [USP'U]/g 1 TUBE in 1	2	Non-preferred Generic	$2.50	$7.50	None
NEOMYCIN SULFATE 500MG TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT	2	Non-preferred Generic	$2.50	$7.50	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS	2	Non-preferred Generic	$2.50	$7.50	None
NEOMYCIN/POLYMY/DEXA EYE DROPS 3.5MG/1ML	2	Non-preferred Generic	$2.50	$7.50	None
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M	2	Non-preferred Generic	$2.50	$7.50	None
NEOMYCIN/POLYMY/HYDRO OTIC SUS	2	Non-preferred Generic	$2.50	$7.50	None
NEOSPORIN EYE DROPS	2	Non-preferred Generic	$2.50	$7.50	None
NEPHRAMINE SOLUTION FOR INJECTION	4	Non-preferred Brand	27%	27%	P
NEULASTA 6MG/0.6ML SYRINGE	4	Non-preferred Brand	27%	27%	P Q:2 /28Days
NEUPOGEN 300MCG/ML VIAL	4	Non-preferred Brand	27%	27%	P Q:14 /30Days
NEUPOGEN 300ug/0.5mL 10 SYRINGE in 1 BOX / 0.5 mL in 1 SYRINGE	4	Non-preferred Brand	27%	27%	P Q:14 /30Days
NEUPOGEN INJECTION 480MCG/0.8ML 10 X 0.8ML SYR	4	Non-preferred Brand	27%	27%	P Q:14 /30Days
NEUPRO 1 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NEUPRO 2 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NEUPRO 3 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NEUPRO 4 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NEUPRO 6 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NEUPRO 8 MG/24 HR PATCH	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NEURONTIN 250MG/5ML TUBEX	4	Non-preferred Brand	27%	27%	None
nevirapine 200 mg tablet	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NEXAVAR TABLETS 200MG 120 BOT	4	Non-preferred Brand	27%	27%	P Q:120 /30Days
NEXT CHOICE 0.75 MG TABLET	3	Preferred Brand	$35.00	$105.00	None
NIACOR 500MG TABLET	2	Non-preferred Generic	$2.50	$7.50	None
NIASPAN 1000MG TABLET (90 CT)	3	Preferred Brand	$35.00	$105.00	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NIASPAN ER 500MG TABLET (90 CT)	3	Preferred Brand	$35.00	$105.00	None
NIASPAN ER 750MG TABLET (90 CT)	3	Preferred Brand	$35.00	$105.00	None
NICARDIPINE HYDROCHLORIDE 2.5mg/mL	2	Non-preferred Generic	$2.50	$7.50	None
NICARDIPINE HYDROCHLORIDE CAPSULES	2	Non-preferred Generic	$2.50	$7.50	None
NICARDIPINE HYDROCHLORIDE CAPSULES 30MG 500 BOT	2	Non-preferred Generic	$2.50	$7.50	None
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL	4	Non-preferred Brand	27%	27%	None
NIFEDIAC CC 90MG TABLET SA	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NIFEDICAL XL 30MG TABLET SR OSMOTIC PUSH 24HR	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NIFEDICAL XL 60MG TABLET SR OSMOTIC PUSH 24HR	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NIFEDIPINE TABLETS EXTENDED RELEASE	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NIFEDIPINE TABLETS EXTENDED RELEASE	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NIFEDIPINE TABLETS EXTENDED RELEASE	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NILANDRON 150MG TABLET	4	Non-preferred Brand	27%	27%	Q:60 /30Days
Nimodipine 30mg/1 10 BLISTER PACK in 1 CARTON / 10 CAPSULE, LIQUID FILLED in 1 BLISTER PACK	4	Non-preferred Brand	27%	27%	None
NIPENT FOR INJECTION 10MG VIALS	4	Non-preferred Brand	27%	27%	P
Nisoldipine 17mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NISOLDIPINE 20MG TB24	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
Nisoldipine 25.5mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
NISOLDIPINE 30MG TB24	3	Preferred Brand	$35.00	$105.00	Q:60 /30Days
Nisoldipine 34mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
NISOLDIPINE 40MG TB24	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
Nisoldipine 8.5mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC	3	Preferred Brand	$35.00	$105.00	Q:30 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NITRO-DUR 0.1 MG/HR PATCH	4	Non-preferred Brand	27%	27%	Q:30 /30Days
NITRO-DUR 0.2 MG/HR PATCH	4	Non-preferred Brand	27%	27%	Q:30 /30Days
NITRO-DUR 0.3 MG/HR PATCH	4	Non-preferred Brand	27%	27%	None
NITRO-DUR 0.4 MG/HR PATCH	4	Non-preferred Brand	27%	27%	Q:60 /30Days
NITRO-DUR 0.6 MG/HR PATCH	4	Non-preferred Brand	27%	27%	Q:30 /30Days
NITRO-DUR 0.8 MG/HR PATCH	4	Non-preferred Brand	27%	27%	None
Nitrofurantoin 25mg/5mL	4	Non-preferred Brand	27%	27%	P
NITROFURANTOIN MCR 50MG CAP	3	Preferred Brand	$35.00	$105.00	P
Nitrofurantoin Monohydrate/Macrocrystals 25; 75mg 100 CAPSULE BOTTLE	3	Preferred Brand	$35.00	$105.00	P
NITROGLYCERIN .2MG/HR PATCH	2	Non-preferred Generic	$2.50	$7.50	Q:30 /30Days
NITROGLYCERIN .4MG/HR PATCH	2	Non-preferred Generic	$2.50	$7.50	Q:60 /30Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NITROGLYCERIN .6MG/HR PATCH	2	Non-preferred Generic	$2.50	$7.50	Q:30 /30Days
Nitroglycerin 5mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 10 mL in 1 VIAL, SINGLE-DOSE	2	Non-preferred Generic	$2.50	$7.50	None
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX	2	Non-preferred Generic	$2.50	$7.50	Q:30 /30Days
Nitrolingual Pumpspray 400ug/1 200 SPRAY, METERED in 1 BOTTLE	4	Non-preferred Brand	27%	27%	None
NITROSTAT 0.3MG TABLET SL	3	Preferred Brand	$35.00	$105.00	None
NITROSTAT 0.4MG TABLET SL	3	Preferred Brand	$35.00	$105.00	None
NITROSTAT 0.6MG TABLET SL	3	Preferred Brand	$35.00	$105.00	None
NIZATIDINE ORAL SOLUTION 15MG/ML	2	Non-preferred Generic	$2.50	$7.50	None
NORETHINDRONE 5MG TABLET	3	Preferred Brand	$35.00	$105.00	None
NORMOSOL -R INJ /D5W	4	Non-preferred Brand	27%	27%	None
NORMOSOL-M AND DEXTROSE 5%	4	Non-preferred Brand	27%	27%	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NORMOSOL-R PH 7.4 IV SOLUTION	4	Non-preferred Brand	27%	27%	None
NORPACE CR 100MG CAPSULE SA	4	Non-preferred Brand	27%	27%	None
NORPACE CR 150MG CAPSULE SA	4	Non-preferred Brand	27%	27%	None
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK in 1 CARTON / 21 TABLET in 1 BLISTER PACK	4	Non-preferred Brand	27%	27%	None
Nortrel (28 Day Regimen) 3 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK	4	Non-preferred Brand	27%	27%	None
NORTREL 1-0.035MG TABLET 28DAY	4	Non-preferred Brand	27%	27%	None
Nortrel 7/7/7 (28 Day Regimen) 6 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER	4	Non-preferred Brand	27%	27%	None
NORTRIPTYLINE HCL 25MG CAP	2	Non-preferred Generic	$2.50	$7.50	None
NORTRIPTYLINE HCL 75MG CAPSULE	2	Non-preferred Generic	$2.50	$7.50	None
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE in 1 BOTTLE	2	Non-preferred Generic	$2.50	$7.50	None
Nortriptyline Hydrochloride 50mg/1 500 CAPSULE in 1 BOTTLE	2	Non-preferred Generic	$2.50	$7.50	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NORVIR 100 MG TABLET	4	Non-preferred Brand	27%	27%	Q:360 /30Days
NORVIR 100mg/1 30 CAPSULE in 1 BOTTLE	4	Non-preferred Brand	27%	27%	Q:360 /30Days
NORVIR 80MG/ML ORAL SOLUTION	4	Non-preferred Brand	27%	27%	Q:480 /30Days
Novolin 100[iU]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL	3	Preferred Brand	$35.00	$105.00	None
Novolin 100[USP'U]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL	3	Preferred Brand	$35.00	$105.00	None
Novolin R 100[iU]/mL 1 VIAL in 1 CARTON / 10 mL in 1 VIAL	3	Preferred Brand	$35.00	$105.00	None
NOVOLOG 100U/ML VIAL	3	Preferred Brand	$35.00	$105.00	None
NOVOLOG FLEXPEN SYRINGE	3	Preferred Brand	$35.00	$105.00	None
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML	3	Preferred Brand	$35.00	$105.00	None
NOVOLOG MIX 70/30 VIAL	3	Preferred Brand	$35.00	$105.00	None
NOXAFIL 200MG/5ML SUSPENSION ORAL	4	Non-preferred Brand	27%	27%	P Q:840 /28Days
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NUEDEXTA 20; 10mg/1; mg/1	4	Non-preferred Brand	27%	27%	Q:60 /30Days
NULOJIX 250mg/1 1 VIAL, SINGLE-USE in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in	4	Non-preferred Brand	27%	27%	P Q:20 /30Days
NULYTELY WITH FLAVOR PACKS POWDER FOR SOLUTION 420;1.48;MG;MG;GM; 4 L BOT	3	Preferred Brand	$35.00	$105.00	None
NYAMYC 100000 U/G POWDER	2	Non-preferred Generic	$2.50	$7.50	None
Nystatin 100000[USP'U]/g	2	Non-preferred Generic	$2.50	$7.50	None
Nystatin 100000[USP'U]/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE	2	Non-preferred Generic	$2.50	$7.50	None
Nystatin 100000[USP'U]/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE	2	Non-preferred Generic	$2.50	$7.50	None
Nystatin 100000[USP'U]/mL	2	Non-preferred Generic	$2.50	$7.50	None
NYSTATIN TABLET 500000U (100 CT)	2	Non-preferred Generic	$2.50	$7.50	None
NYSTATIN/TRIAMCINOLONE CRM	2	Non-preferred Generic	$2.50	$7.50	None
NYSTATIN/TRIAMCINOLONE OINT 10000UNT/1MG	2	Non-preferred Generic	$2.50	$7.50	None
Drug Name	Tier Nbr.	Tier Description	30-Day Preferred Pharm	90-Day Mail Order	Drug Usage Mgmt
NYSTOP 100000U/GM POWDER	2	Non-preferred Generic	$2.50	$7.50	None

Chart Legend:

Below are a few notes to help you understand the above 2013 Medicare Part D Reader''s Digest Value Rx (PDP) Plan Formulary.

Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).
Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.
Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $325 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.
Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
- Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.
- No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.
Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
- Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
- Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
- Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2970) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
- Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
- None - This drug does not fall under any drug utilization management controls.
- P - Prior Authorization -This drug is subject to prior authorization.
- S - Step Therapy -This drug is subject to step therapy.
- Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.

(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2013 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.