2014 Medicare Part D Plan Formulary Information |
Coventry Total Care (HMO) (H3144-001-0)
Benefit Details
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The Coventry Total Care (HMO) (H3144-001-0) Formulary Drugs Starting with the Letter A in BOONE County, IL: CMS MA Region 14 which includes: IL Plan Monthly Premium: $0.00 Deductible: $0 |
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
A-HYDROCORT 100MG VIAL ![Compare how all Medicare Part D PDP plans in IL cover A-HYDROCORT 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ABACAVIR 300 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABACAVIR 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir] ![Compare how all Medicare Part D PDP plans in IL cover Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ABILIFY 10MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ABILIFY 15MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ABILIFY 1MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 1MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:900 /30Days |
ABILIFY 20MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ABILIFY 2MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ABILIFY 30MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ABILIFY 5MG TABLET (OTSUKA) ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY 5MG TABLET (OTSUKA).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABILIFY DISCMELT 10MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY DISCMELT 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
ABILIFY DISCMELT 15MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY DISCMELT 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
ABILIFY INJ 9.75MG ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY INJ 9.75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ABILIFY MAINTENA ER 300 MG VL ![Compare how all Medicare Part D PDP plans in IL cover ABILIFY MAINTENA ER 300 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:1 /30Days |
ABSTRAL 100 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 100 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:120 /30Days |
ABSTRAL 200 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 200 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
ABSTRAL 300 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 300 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
ABSTRAL 400 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 400 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
ABSTRAL 600 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 600 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
ABSTRAL 800 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in IL cover ABSTRAL 800 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
Acamprosate Calcium DR 333 MG tablets [Campral] ![Compare how all Medicare Part D PDP plans in IL cover Acamprosate Calcium DR 333 MG tablets [Campral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Acarbose 100mg/1 1000 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IL cover Acarbose 100mg/1 1000 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ACARBOSE 25 MG TABLETS ![Compare how all Medicare Part D PDP plans in IL cover ACARBOSE 25 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Acarbose 50mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Acarbose 50mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ACEBUTOLOL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover ACEBUTOLOL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ACEBUTOLOL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover ACEBUTOLOL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE ![Compare how all Medicare Part D PDP plans in IL cover ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Acetaminophen and Codeine Phosphate 300; 60mg/1; mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Acetaminophen and Codeine Phosphate 300; 60mg/1; mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:390 /30Days |
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD ![Compare how all Medicare Part D PDP plans in IL cover ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:4950 /30Days |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT) ![Compare how all Medicare Part D PDP plans in IL cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:390 /30Days |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:390 /30Days |
ACETAZOLAMIDE 125MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ACETAZOLAMIDE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETAZOLAMIDE 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover ACETAZOLAMIDE 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in IL cover ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ACETIC ACID 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in IL cover ACETIC ACID 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ACETYLCYSTEINE 10% VIAL ![Compare how all Medicare Part D PDP plans in IL cover ACETYLCYSTEINE 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN ![Compare how all Medicare Part D PDP plans in IL cover ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ACITRETIN 10 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in IL cover ACITRETIN 10 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
ACITRETIN 17.5 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in IL cover ACITRETIN 17.5 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
ACITRETIN 25 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in IL cover ACITRETIN 25 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
ACTEMRA 162 MG/0.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in IL cover ACTEMRA 162 MG/0.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ACTEMRA INJECTION 200MG/10ML ![Compare how all Medicare Part D PDP plans in IL cover ACTEMRA INJECTION 200MG/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:20 /28Days |
ACTHIB VACCINE VIAL 10-24UNT/5ML ![Compare how all Medicare Part D PDP plans in IL cover ACTHIB VACCINE VIAL 10-24UNT/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTIMMUNE 100 MCG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ACTIMMUNE 100 MCG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Actonel 150mg/1 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 1 FILM COATED TABLETS in TRAY ![Compare how all Medicare Part D PDP plans in IL cover Actonel 150mg/1 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 1 FILM COATED TABLETS in TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:1 /30Days |
Actonel 30mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Actonel 30mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
Actonel 35mg/1 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 4 FILM COATED TABLETS in TRAY ![Compare how all Medicare Part D PDP plans in IL cover Actonel 35mg/1 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 4 FILM COATED TABLETS in TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:4 /28Days |
Actonel 5mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Actonel 5mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA ![Compare how all Medicare Part D PDP plans in IL cover ACUVAIL 0.45% OPHTH SOLUTION #30X0.4 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
ACYCLOVIR 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover ACYCLOVIR 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Acyclovir 200mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Acyclovir 200mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Acyclovir 400mg/1 ![Compare how all Medicare Part D PDP plans in IL cover Acyclovir 400mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Acyclovir 5% Ointment ![Compare how all Medicare Part D PDP plans in IL cover Acyclovir 5% Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ACYCLOVIR 800 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ACYCLOVIR 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACYCLOVIR SODIUM 500MG VIAL ![Compare how all Medicare Part D PDP plans in IL cover ACYCLOVIR SODIUM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in IL cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ADAGEN 250U/ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ADAGEN 250U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA] ![Compare how all Medicare Part D PDP plans in IL cover ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:2 /30Days |
ADCIRCA TABLETS 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in IL cover ADCIRCA TABLETS 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera] ![Compare how all Medicare Part D PDP plans in IL cover ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
ADEMPAS 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ADEMPAS 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ADEMPAS 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ADEMPAS 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ADEMPAS 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ADEMPAS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADVAIR DISKUS MIS 100/50 ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR DISKUS MIS 100/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:60 /30Days |
ADVAIR DISKUS MIS 250/50 ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR DISKUS MIS 250/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:60 /30Days |
ADVAIR DISKUS MIS 500/50 ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR DISKUS MIS 500/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:60 /30Days |
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:12 /30Days |
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:12 /30Days |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in IL cover ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:12 /30Days |
ADVICOR ER 20-750MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IL cover ADVICOR ER 20-750MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
ADVICOR EXTENDED RELEASE TABLETS 20;1000MG;MG 90 BOTPL ![Compare how all Medicare Part D PDP plans in IL cover ADVICOR EXTENDED RELEASE TABLETS 20;1000MG;MG 90 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
ADVICOR EXTENDED RELEASE TABLETS 20;500MG;MG 90 BOTPL ![Compare how all Medicare Part D PDP plans in IL cover ADVICOR EXTENDED RELEASE TABLETS 20;500MG;MG 90 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ADVICOR EXTENDED RELEASE TABLETS 40;1000MG;MG 90 BOTPL ![Compare how all Medicare Part D PDP plans in IL cover ADVICOR EXTENDED RELEASE TABLETS 40;1000MG;MG 90 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AFEDITAB CR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in IL cover AFEDITAB CR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFEDITAB CR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in IL cover AFEDITAB CR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR DISPERZ 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR DISPERZ 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR DISPERZ 3 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR DISPERZ 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR DISPERZ 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR DISPERZ 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR TABLETS 2.5 MG ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR TABLETS 2.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AFINITOR TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in IL cover AFINITOR TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AGGRENOX 25-200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AGGRENOX 25-200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
AK-CON 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IL cover AK-CON 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AKNE-MYCIN 2% OINTMENT ![Compare how all Medicare Part D PDP plans in IL cover AKNE-MYCIN 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBENZA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALBENZA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ALBUTEROL SULFATE 4MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE 4MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALBUTEROL SULFATE 8MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE 8MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ALBUTEROL SULFATE SOLUTION FOR INHALATION ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE SOLUTION FOR INHALATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | P |
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALBUTEROL SULFATE TABLET 2MG (500 CT) ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL SULFATE TABLET 2MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALBUTEROL TABLET 4MG (500 CT) ![Compare how all Medicare Part D PDP plans in IL cover ALBUTEROL TABLET 4MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALCLOMETASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IL cover ALCLOMETASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Alclometasone Dipropionate 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IL cover Alclometasone Dipropionate 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ALDURAZYME 2.9MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ALDURAZYME 2.9MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ALENDRONATE SODIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALENDRONATE SODIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Alendronate Sodium 35mg, 4 BLISTER PACK in 1 BOX / 1 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Alendronate Sodium 35mg, 4 BLISTER PACK in 1 BOX / 1 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALENDRONATE SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALENDRONATE SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALENDRONATE SODIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALENDRONATE SODIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Alendronate Sodium 70 mg tab ![Compare how all Medicare Part D PDP plans in IL cover Alendronate Sodium 70 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ALIMTA 500MG VIAL ![Compare how all Medicare Part D PDP plans in IL cover ALIMTA 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ALINIA 100MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in IL cover ALINIA 100MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ALINIA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALINIA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALLOPURINOL 100 MG TABLETS ![Compare how all Medicare Part D PDP plans in IL cover ALLOPURINOL 100 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ALOCRIL 2% EYE DROPS ![Compare how all Medicare Part D PDP plans in IL cover ALOCRIL 2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:10 /30Days |
ALOMIDE 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IL cover ALOMIDE 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ALORA 0.025 MG PATCH ![Compare how all Medicare Part D PDP plans in IL cover ALORA 0.025 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:8 /28Days |
ALORA 0.05 MG PATCH ![Compare how all Medicare Part D PDP plans in IL cover ALORA 0.05 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:8 /28Days |
ALORA 0.075 MG PATCH ![Compare how all Medicare Part D PDP plans in IL cover ALORA 0.075 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:8 /28Days |
ALORA 0.1 MG PATCH ![Compare how all Medicare Part D PDP plans in IL cover ALORA 0.1 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:8 /28Days |
ALPHAGAN P 0.1% DROPS ![Compare how all Medicare Part D PDP plans in IL cover ALPHAGAN P 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
ALPHAGAN P 0.15% EYE DROPS ![Compare how all Medicare Part D PDP plans in IL cover ALPHAGAN P 0.15% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
ALPRAZOLAM 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALPRAZOLAM 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALPRAZOLAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALPRAZOLAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:150 /30Days |
ALPRAZOLAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALPRAZOLAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:150 /30Days |
ALPRAZOLAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ALPRAZOLAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:150 /30Days |
ALREX 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in IL cover ALREX 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:15 /30Days |
ALTABAX 10mg/g 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IL cover ALTABAX 10mg/g 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:15 /30Days |
ALTOPREV 20MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IL cover ALTOPREV 20MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
ALTOPREV 40MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IL cover ALTOPREV 40MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
ALTOPREV 60MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in IL cover ALTOPREV 60MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
ALVESCO 160MCG/ACT AERS ![Compare how all Medicare Part D PDP plans in IL cover ALVESCO 160MCG/ACT AERS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:12 /30Days |
ALVESCO 80MCG/ACT AERS ![Compare how all Medicare Part D PDP plans in IL cover ALVESCO 80MCG/ACT AERS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:12 /30Days |
AMANTADINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMANTADINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMANTADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMANTADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMBISOME 50MG VIAL ![Compare how all Medicare Part D PDP plans in IL cover AMBISOME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
AMCINONIDE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IL cover AMCINONIDE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMCINONIDE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in IL cover AMCINONIDE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMCINONIDE 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in IL cover AMCINONIDE 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Amethia 2 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Amethia 2 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK per CARTON / 28 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK per CARTON / 28 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMIFOSTINE 50mg/mL 3 VIAL, SINGLE-USE per CARTON / 10 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in IL cover AMIFOSTINE 50mg/mL 3 VIAL, SINGLE-USE per CARTON / 10 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
AMIKACIN SULFATE 500 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover AMIKACIN SULFATE 500 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMILORIDE HCL W/HCTZ 5MG-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in IL cover AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Aminophylline 25mg/mL 5 TRAY per CARTON / 5 AMPULE in 1 TRAY / 10 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in IL cover Aminophylline 25mg/mL 5 TRAY per CARTON / 5 AMPULE in 1 TRAY / 10 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMINOSYN HBC INJECTION SULFITE FREE 7% ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN HBC INJECTION SULFITE FREE 7%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN II 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN II 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN II 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN II 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN II 8.5% ELECTROLYT ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN II 8.5% ELECTROLYT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN II 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN II 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
Aminosyn II Sulfite-Free 1490; 1527; 1050; 1107; 750; 450; 990; 1500; 1575; 258; 405; 447; 1083; 79 ![Compare how all Medicare Part D PDP plans in IL cover Aminosyn II Sulfite-Free 1490; 1527; 1050; 1107; 750; 450; 990; 1500; 1575; 258; 405; 447; 1083; 79.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN M 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN M 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN PF INJECTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN PF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5% ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
AMINOSYN-PF 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AMINOSYN-PF 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMIODARONE HCL 200MG 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AMIODARONE HCL 200MG 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMIODARONE HCL 400MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMIODARONE HCL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMITIZA 8MCG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMITIZA 8MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:60 /30Days |
AMITIZA CAPSULES 24MCG 60 CAP BOT ![Compare how all Medicare Part D PDP plans in IL cover AMITIZA CAPSULES 24MCG 60 CAP BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:60 /30Days |
AMITRIP/CDP 25-10 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/CDP 25-10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIP/PERPHEN 10-2 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/PERPHEN 10-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIP/PERPHEN 10-4 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/PERPHEN 10-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIP/PERPHEN 25-2 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/PERPHEN 25-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIP/PERPHEN 25-4 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/PERPHEN 25-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIP/PERPHEN 50-4 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIP/PERPHEN 50-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMITRIPTYLINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIPTYLINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMITRIPTYLINE HCL 150 MG TAB ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL 25MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL 75MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in IL cover AMITRIPTYLINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMLODIPINE BESYLATE 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE 2.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMLODIPINE BESYLATE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
AMLODIPINE-BENAZEPRIL 10-40 MG ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE-BENAZEPRIL 10-40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
AMLODIPINE-BENAZEPRIL 5-40 MG ![Compare how all Medicare Part D PDP plans in IL cover AMLODIPINE-BENAZEPRIL 5-40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
ammonium lactate 12% cream ![Compare how all Medicare Part D PDP plans in IL cover ammonium lactate 12% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in IL cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Amnesteem 10mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Amnesteem 10mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Amnesteem 20mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Amnesteem 20mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Amnesteem 40mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Amnesteem 40mg/1 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
amox tr-k clv 200-28.5/5 susp ![Compare how all Medicare Part D PDP plans in IL cover amox tr-k clv 200-28.5/5 susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOX TR-K CLV 500-125 MG TAB ![Compare how all Medicare Part D PDP plans in IL cover AMOX TR-K CLV 500-125 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in IL cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in IL cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in IL cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOXAPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXICILLIN 125MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN 125MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Amoxicillin 250mg/1 500 TABLET, CHEWABLE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Amoxicillin 250mg/1 500 TABLET, CHEWABLE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN 500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN 500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Amoxicillin 500mg/1 500 CAPSULE BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IL cover Amoxicillin 500mg/1 500 CAPSULE BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN 875MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN 875MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL ![Compare how all Medicare Part D PDP plans in IL cover AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALT COMBO 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPHETAMINE SALT COMBO 15MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALT COMBO 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPHETAMINE SALT COMBO 30MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALT COMBO 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPHETAMINE SALT COMBO 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALT COMBO 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPHETAMINE SALTS 20MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALTS 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPHETAMINE SALTS 5 MG TAB ![Compare how all Medicare Part D PDP plans in IL cover AMPHETAMINE SALTS 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
amphotericin b 50mg/10mL 10 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in IL cover amphotericin b 50mg/10mL 10 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in IL cover Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPICILLIN CAPSULES 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN CAPSULES 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPICILLIN FOR INJECTION POWDER ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN FOR INJECTION POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AMPICILLIN POWDER FOR INJECTION 1 GM/ML ![Compare how all Medicare Part D PDP plans in IL cover AMPICILLIN POWDER FOR INJECTION 1 GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
ampicillin-sulbactam 15 gm vl ![Compare how all Medicare Part D PDP plans in IL cover ampicillin-sulbactam 15 gm vl.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ampicillin-sulbactam 3 gm vial ![Compare how all Medicare Part D PDP plans in IL cover ampicillin-sulbactam 3 gm vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AMPYRA ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AMPYRA ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
Anastrozole 1mg/1 90 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IL cover Anastrozole 1mg/1 90 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:30 /30Days |
ANDROGEL 1%(50MG) GEL PACKET ![Compare how all Medicare Part D PDP plans in IL cover ANDROGEL 1%(50MG) GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP ![Compare how all Medicare Part D PDP plans in IL cover Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
ANGELIQ 0.25 MG-0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ANGELIQ 0.25 MG-0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANGELIQ 1-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ANGELIQ 1-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ANTARA 130 MG CAPSULES ![Compare how all Medicare Part D PDP plans in IL cover ANTARA 130 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
ANTARA 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover ANTARA 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
ANTARA 43 MG CAPSULES ![Compare how all Medicare Part D PDP plans in IL cover ANTARA 43 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
ANTARA 90 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover ANTARA 90 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
Apexicon E 0.05% Cream ![Compare how all Medicare Part D PDP plans in IL cover Apexicon E 0.05% Cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
APOKYN 30 MG/3 ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in IL cover APOKYN 30 MG/3 ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER per CARTON / 10 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in IL cover Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER per CARTON / 10 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in IL cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
APRISO CP24 ![Compare how all Medicare Part D PDP plans in IL cover APRISO CP24.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
APTIOM 200 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover APTIOM 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
APTIOM 400 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover APTIOM 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:30 /30Days |
APTIOM 600 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover APTIOM 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:60 /30Days |
APTIOM 800 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover APTIOM 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:30 /30Days |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IL cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT ![Compare how all Medicare Part D PDP plans in IL cover APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Aralast NP 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in IL cover Aralast NP 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in IL cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARANESP 200MCG/0.4ML SYRINGE ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 200MCG/0.4ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ARANESP 200MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 200MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARANESP 300MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 300MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ARANESP 500MCG/1ML SYRINGE ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 500MCG/1ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1 /21Days |
ARANESP 60MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 60MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IL cover ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR ![Compare how all Medicare Part D PDP plans in IL cover ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR ![Compare how all Medicare Part D PDP plans in IL cover ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR ![Compare how all Medicare Part D PDP plans in IL cover ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:4 /28Days |
ARCALYST INJECTION 220MG/VIAL ![Compare how all Medicare Part D PDP plans in IL cover ARCALYST INJECTION 220MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:8 /30Days |
Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IL cover Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ASACOL HD 800mg/1 12 BOTTLE CASE / 180 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover ASACOL HD 800mg/1 12 BOTTLE CASE / 180 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Ascomp with Codeine 325; 50; 40; 30mg/1; mg/1; mg/1; mg/1 500 CAPSULE BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IL cover Ascomp with Codeine 325; 50; 40; 30mg/1; mg/1; mg/1; mg/1 500 CAPSULE BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
ASMANEX TWISTHALER 110 MCG #30 ![Compare how all Medicare Part D PDP plans in IL cover ASMANEX TWISTHALER 110 MCG #30.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1 /30Days |
ASMANEX TWISTHALER 220MCG #120 ![Compare how all Medicare Part D PDP plans in IL cover ASMANEX TWISTHALER 220MCG #120.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1 /30Days |
ASMANEX TWISTHALER 220MCG #30 ![Compare how all Medicare Part D PDP plans in IL cover ASMANEX TWISTHALER 220MCG #30.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1 /30Days |
ASMANEX TWISTHALER 220MCG #60 ![Compare how all Medicare Part D PDP plans in IL cover ASMANEX TWISTHALER 220MCG #60.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1 /30Days |
ATACAND 16MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ATACAND 16MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ATACAND 32MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ATACAND 32MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ATACAND 4MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ATACAND 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ATACAND 8MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ATACAND 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
ATENOLOL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover ATENOLOL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Atenolol 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Atenolol 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATENOLOL TABLET USP 50MG (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover ATENOLOL TABLET USP 50MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ATENOLOL-CHLORTHALIDONE 100-25 ![Compare how all Medicare Part D PDP plans in IL cover ATENOLOL-CHLORTHALIDONE 100-25.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IL cover ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ATORVASTATIN 10 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in IL cover ATORVASTATIN 10 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ATORVASTATIN 20 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in IL cover ATORVASTATIN 20 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ATORVASTATIN 40 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in IL cover ATORVASTATIN 40 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ATORVASTATIN 80 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in IL cover ATORVASTATIN 80 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ATOVAQUONE 750 MG/5 ML SUSP [Mepron] ![Compare how all Medicare Part D PDP plans in IL cover ATOVAQUONE 750 MG/5 ML SUSP [Mepron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IL cover Atripla 600; 200; 300mg/1; mg/1; mg/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 | Q:30 /30Days |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in IL cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:26 /30Days |
AUBAGIO 14 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AUBAGIO 14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AUBAGIO 7 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AUBAGIO 7 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AUGMENTED BETAMETHASONE DIPROPIONATE OINTMENT ![Compare how all Medicare Part D PDP plans in IL cover AUGMENTED BETAMETHASONE DIPROPIONATE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AVANDAMET 1000; 2mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDAMET 1000; 2mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDAMET 1000; 4mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDAMET 1000; 4mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDAMET 500; 2mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDAMET 500; 2mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDAMET 500; 4mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDAMET 500; 4mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDARYL 1; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDARYL 1; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDARYL 2; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDARYL 2; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDARYL 2; 8mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDARYL 2; 8mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AVANDARYL 4; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDARYL 4; 4mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDARYL 4; 8mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDARYL 4; 8mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVANDIA 2mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDIA 2mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDIA 4mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDIA 4mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:60 /30Days |
AVANDIA 8mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover AVANDIA 8mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AVASTIN 100MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in IL cover AVASTIN 100MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
AVELOX 400MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AVELOX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AVELOX ABC PACK 400MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AVELOX ABC PACK 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AVELOX IV 400MG/250ML ![Compare how all Medicare Part D PDP plans in IL cover AVELOX IV 400MG/250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in IL cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AVODART 0.5MG SOFTGEL ![Compare how all Medicare Part D PDP plans in IL cover AVODART 0.5MG SOFTGEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:30 /30Days |
AVONEX ADMIN PACK 30MCG SYR ![Compare how all Medicare Part D PDP plans in IL cover AVONEX ADMIN PACK 30MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /30Days |
AVONEX ADMIN PACK 30MCG VL ![Compare how all Medicare Part D PDP plans in IL cover AVONEX ADMIN PACK 30MCG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AXERT 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AXERT 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:8 /30Days |
AXERT 6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AXERT 6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S Q:8 /30Days |
Azacitidine 100 mg vial [Vidaza] ![Compare how all Medicare Part D PDP plans in IL cover Azacitidine 100 mg vial [Vidaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
AZASITE 1% DROPS ![Compare how all Medicare Part D PDP plans in IL cover AZASITE 1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:3 /14Days |
AZATHIOPRINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AZATHIOPRINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AZELASTINE 0.15% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IL cover AZELASTINE 0.15% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AZELASTINE 137 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IL cover AZELASTINE 137 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |
AZELEX 20% CREAM 30GM TUBE ![Compare how all Medicare Part D PDP plans in IL cover AZELEX 20% CREAM 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AZILECT 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AZILECT 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
AZILECT 1MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AZILECT 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZITHROMYCIN 1 GM PWD PACKET ![Compare how all Medicare Part D PDP plans in IL cover AZITHROMYCIN 1 GM PWD PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:2 /30Days |
Azithromycin 100mg/5mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Azithromycin 100mg/5mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Azithromycin 200mg/5mL 22.5 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Azithromycin 200mg/5mL 22.5 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AZITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in IL cover AZITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION ![Compare how all Medicare Part D PDP plans in IL cover Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Azithromycin 600mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IL cover Azithromycin 600mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in IL cover AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
AZTREONAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in IL cover AZTREONAM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$7.00 | $21.00 | None |