2014 Medicare Part D Plan Formulary Information |
SeniorBlue - Option 2 (PPO) (H3923-013-0)
Sanctioned Plan
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The SeniorBlue - Option 2 (PPO) (H3923-013-0) Formulary Drugs Starting with the Letter V in FRANKLIN County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $78.60 Deductible: $0 |
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VAGIFEM 10 MCG VAGINAL TAB ![Compare how all Medicare Part D PDP plans in PA cover VAGIFEM 10 MCG VAGINAL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VALACYCLOVIR 1000 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALACYCLOVIR 1000 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VALACYCLOVIR 500 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALACYCLOVIR 500 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VALCYTE 450MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALCYTE 450MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VALCYTE FOR ORAL SOLUTION 50MG/ML ![Compare how all Medicare Part D PDP plans in PA cover VALCYTE FOR ORAL SOLUTION 50MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Valium 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Valium 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P Q:120 /30Days |
Valium 2mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Valium 2mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P Q:60 /30Days |
Valium 5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Valium 5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P Q:60 /30Days |
Valproate Sodium 100mg/mL 10 VIAL, SINGLE-DOSE in 1 BOX / 5 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover Valproate Sodium 100mg/mL 10 VIAL, SINGLE-DOSE in 1 BOX / 5 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
Valproic 250mg/1 100 CAPSULE, LIQUID FILLED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Valproic 250mg/1 100 CAPSULE, LIQUID FILLED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Valproic Acid 250mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Valproic Acid 250mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VALSARTAN-HCTZ 160-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 160-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | Q:60 /30Days |
VALSARTAN-HCTZ 160-25 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 160-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | Q:60 /30Days |
VALSARTAN-HCTZ 320-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 320-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | Q:60 /30Days |
VALSARTAN-HCTZ 320-25 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 320-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | Q:60 /30Days |
VALSARTAN-HCTZ 80-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 80-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | Q:60 /30Days |
VALTREX 1GM CAPLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover VALTREX 1GM CAPLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VALTREX 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALTREX 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VANCOCIN HCL 125MG PULVULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOCIN HCL 125MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VANCOCIN HCL 250MG PULVULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOCIN HCL 250MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VANCOMYCIN HCL 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VANCOMYCIN HCL 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ) ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA ![Compare how all Medicare Part D PDP plans in PA cover Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE) ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in PA cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VANOS 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover VANOS 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VAQTA 25 UNITS/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover VAQTA 25 UNITS/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in PA cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VASCEPA 1 GM CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VASCEPA 1 GM CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VASERETIC 10-25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VASERETIC 10-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
Vasotec 10mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Vasotec 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VASOTEC 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VASOTEC 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
VASOTEC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VASOTEC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
VASOTEC 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VASOTEC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
VECTICAL OINTMENT 3MCG/GM 100 GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover VECTICAL OINTMENT 3MCG/GM 100 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VELCADE 3.5MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VELCADE 3.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VELTIN 10; 0.25mg/g; mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover VELTIN 10; 0.25mg/g; mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VENLAFAXINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HCL 37.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 37.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENLAFAXINE HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HCL ER TAB 225 MG ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER TAB 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Ventavis 0.01mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Ventavis 0.01mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Ventavis 0.02mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Ventavis 0.02mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in PA cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAMYST 27.5MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover VERAMYST 27.5MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL 2.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 2.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL ER 180 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VERAPAMIL HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAPAMIL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
VERAPAMIL HCL CAPSULES SUSTAINED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL HCL CAPSULES SUSTAINED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
Verapamil Hydrochloride 120mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTEN ![Compare how all Medicare Part D PDP plans in PA cover Verapamil Hydrochloride 120mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $15.00 | None |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN 360MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN 360MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN PM 100MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN PM 100MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERELAN PM 200MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN PM 200MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERELAN PM 300MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERELAN PM 300MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT ![Compare how all Medicare Part D PDP plans in PA cover VERIPRED 20 ORAL SOLUTION 20MG/5ML 8 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VERSACLOZ 50 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover VERSACLOZ 50 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VESICARE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VESICARE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VESICARE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover VESICARE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vestura 3 mg-0.02 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Vestura 3 mg-0.02 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VEXOL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover VEXOL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VFEND 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VFEND 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VFEND 40MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover VFEND 40MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VFEND 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VFEND 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VFEND IV 200MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VFEND IV 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIBRAMYCIN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VIBRAMYCIN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIBRAMYCIN 25MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover VIBRAMYCIN 25MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIBRAMYCIN 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover VIBRAMYCIN 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VICODIN 5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VICODIN 5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VICODIN ES 7.5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VICODIN ES 7.5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VICODIN HP 10-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VICODIN HP 10-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VICOPROFEN 200/7.5 TABLET ![Compare how all Medicare Part D PDP plans in PA cover VICOPROFEN 200/7.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VICTOZA 3-PAK 18 MG/3 ML PEN ![Compare how all Medicare Part D PDP plans in PA cover VICTOZA 3-PAK 18 MG/3 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S |
VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU ![Compare how all Medicare Part D PDP plans in PA cover VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VIDEX 2GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in PA cover VIDEX 2GM PEDIATRIC TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIDEX EC 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover VIDEX EC 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIDEX EC 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover VIDEX EC 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIDEX EC 400MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover VIDEX EC 400MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL] ![Compare how all Medicare Part D PDP plans in PA cover VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIGABATRIN 500 MG ORAL TABLET [SABRIL] ![Compare how all Medicare Part D PDP plans in PA cover VIGABATRIN 500 MG ORAL TABLET [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover VIGAMOX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIIBRYD 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | S |
VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | S |
VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | S |
VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIMOVO 375-20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIMOVO 375-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIMOVO 500-20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIMOVO 500-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIMPAT 10 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover VIMPAT 10 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIRAMUNE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRAMUNE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIRAMUNE XR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRAMUNE XR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIREAD 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIREAD 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIREAD 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIREAD 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$38.00 | $114.00 | None |
VIREAD POWDER ![Compare how all Medicare Part D PDP plans in PA cover VIREAD POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIROPTIC 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover VIROPTIC 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VISTARIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VISTARIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
VISTARIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VISTARIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VISTIDE 75MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover VISTIDE 75MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VIVACTIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIVACTIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VIVACTIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIVACTIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in PA cover Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in PA cover Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P ![Compare how all Medicare Part D PDP plans in PA cover Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA ![Compare how all Medicare Part D PDP plans in PA cover Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in PA cover VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
VIVITROL INJECTABLE SUSPENSION 380MG/VIAL ![Compare how all Medicare Part D PDP plans in PA cover VIVITROL INJECTABLE SUSPENSION 380MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Voltaren 10mg/g ![Compare how all Medicare Part D PDP plans in PA cover Voltaren 10mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VOLTAREN-XR 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover VOLTAREN-XR 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Voriconazole 200mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Voriconazole 200mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Voriconazole 40 mg/ml susp ![Compare how all Medicare Part D PDP plans in PA cover Voriconazole 40 mg/ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Voriconazole 50mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Voriconazole 50mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VOSPIRE ER 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VOSPIRE ER 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VOSPIRE ER 8 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VOSPIRE ER 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VOTRIENT 200mg/1 120 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VOTRIENT 200mg/1 120 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Vyfemla 28 tablet ![Compare how all Medicare Part D PDP plans in PA cover Vyfemla 28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$17.00 | $51.00 | None |
VYTORIN 10/10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover VYTORIN 10/10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | S Q:30 /30Days |
VYTORIN 10/20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover VYTORIN 10/20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:30 /30Days |
VYTORIN 10/40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover VYTORIN 10/40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:30 /30Days |
VYTORIN 10/80MG TABLET 2500 BOT ![Compare how all Medicare Part D PDP plans in PA cover VYTORIN 10/80MG TABLET 2500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VYVANSE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VYVANSE 40MG CAPSULE 100 EA ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE 40MG CAPSULE 100 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VYVANSE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VYVANSE 70MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE 70MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VYVANSE CAPSULES 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE CAPSULES 20MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
VYVANSE CAPSULES 60MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover VYVANSE CAPSULES 60MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |