2015 Medicare Part D Plan Formulary Information |
Freedom Blue PPO HD Rx (PPO) (H3916-025-0)
Benefit Details
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The Freedom Blue PPO HD Rx (PPO) (H3916-025-0) Formulary Drugs Starting with the Letter O in JUNIATA County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $70.00 Deductible: $0 |
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCTAGAM 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover OCTAGAM 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OCTAGAM 5% VIAL ![Compare how all Medicare Part D PDP plans in PA cover OCTAGAM 5% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OCUFEN 0.03% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover OCUFEN 0.03% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OCUFLOX 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover OCUFLOX 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in PA cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OFEV 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OFEV 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:62 /31Days |
OFEV 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OFEV 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:62 /31Days |
OFLOXACIN 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OFLOXACIN 300 MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 300 MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Ofloxacin 3mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Ofloxacin 3mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OFLOXACIN 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OGESTREL TABLET 0.05MG/0.5MG ![Compare how all Medicare Part D PDP plans in PA cover OGESTREL TABLET 0.05MG/0.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 10 MG VIAL [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 10 MG VIAL [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 2.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 2.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE 7.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 7.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE ODT 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE ODT 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE ODT 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE ODT 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE-FLUOXETINE 12-25 MG ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 12-25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE-FLUOXETINE 12-50 MG ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 12-50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
olanzapine-fluoxetine 3-25 mg ![Compare how all Medicare Part D PDP plans in PA cover olanzapine-fluoxetine 3-25 mg.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLANZAPINE-FLUOXETINE 6-25 MG ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 6-25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE-FLUOXETINE 6-50 MG ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 6-50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLOPATADINE 665 MCG NASAL SPRY ![Compare how all Medicare Part D PDP plans in PA cover OLOPATADINE 665 MCG NASAL SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OLYSIO 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OLYSIO 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza] ![Compare how all Medicare Part D PDP plans in PA cover OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
OMEPRAZOLE 20mg DELAYED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE 20mg DELAYED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
OMEPRAZOLE CAPSULES DELAYED RELEASE 40 MG ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE CAPSULES DELAYED RELEASE 40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
OMEPRAZOLE-BICARB 20-1,100 CAP ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE-BICARB 20-1,100 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OMEPRAZOLE-BICARB 40-1,100 CAP ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE-BICARB 40-1,100 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OMNARIS 50MCG SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in PA cover OMNARIS 50MCG SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG ![Compare how all Medicare Part D PDP plans in PA cover OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in PA cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
Oncaspar 750[iU]/mL 1 VIAL, SINGLE-USE per CARTON / 5 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in PA cover Oncaspar 750[iU]/mL 1 VIAL, SINGLE-USE per CARTON / 5 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
ONDANSETRON 2mg/mL 25 VIAL in 1 CARTON / 2 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON 2mg/mL 25 VIAL in 1 CARTON / 2 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
ONDANSETRON 4 MG/2 ML ISECURE ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON 4 MG/2 ML ISECURE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
ONDANSETRON HCL 24 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HCL 24 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
ONDANSETRON HCL 4MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HCL 4MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
ONDANSETRON HYDROCHLORIDE 4MG ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HYDROCHLORIDE 4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
ONDANSETRON HYDROCHLORIDE 8MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HYDROCHLORIDE 8MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
ONDANSETRON ODT 4MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON ODT 4MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
ONDANSETRON ODT 8MG (10 CT) ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON ODT 8MG (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ONFI 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONFI 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ONFI 2.5 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover ONFI 2.5 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ONFI 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONFI 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ONGLYZA 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONGLYZA 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ONGLYZA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONGLYZA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OPANA 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
OPANA 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
OPANA ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPANA ER 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPANA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPANA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPANA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPANA ER 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPANA ER 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPANA ER 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OPDIVO 40 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover OPDIVO 40 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OPRELVEKIN 5 MG/ML INJECTABLE SOLUTION [NEUMEGA] ![Compare how all Medicare Part D PDP plans in PA cover OPRELVEKIN 5 MG/ML INJECTABLE SOLUTION [NEUMEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
OPSUMIT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPSUMIT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ORAP 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORAP 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ORAP 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORAP 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ORAPRED ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORAPRED ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ORAPRED ODT 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORAPRED ODT 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
ORAPRED ODT 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORAPRED ODT 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORENCIA 125 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ORENCIA 125 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ORENITRAM ER 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
ORENITRAM ER 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ORENITRAM ER 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ORENITRAM ER 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ORFADIN 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ORFADIN 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
ORFADIN 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ORFADIN 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
ORFADIN 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ORFADIN 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Orsythia 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Orsythia 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
ORTHO TRI CYCLEN Lo 6 DIALPACK per CARTON / 1 KIT in 1 DIALPACK ![Compare how all Medicare Part D PDP plans in PA cover ORTHO TRI CYCLEN Lo 6 DIALPACK per CARTON / 1 KIT in 1 DIALPACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
OSMOPREP TABLET 1.5GM ![Compare how all Medicare Part D PDP plans in PA cover OSMOPREP TABLET 1.5GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Otezla 10-20-30MG ![Compare how all Medicare Part D PDP plans in PA cover Otezla 10-20-30MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OTEZLA 28 DAY STARTER PACK ![Compare how all Medicare Part D PDP plans in PA cover OTEZLA 28 DAY STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OTEZLA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OTEZLA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
OTREXUP 10 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 10 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OTREXUP 15 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 15 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OTREXUP 20 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 20 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OTREXUP 25 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 25 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OVIDE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in PA cover OVIDE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXACILLIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 1GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Oxacillin 2 gm add-vantage vl ![Compare how all Medicare Part D PDP plans in PA cover Oxacillin 2 gm add-vantage vl.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXALIPLATIN 5 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover OXALIPLATIN 5 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
oxandrolone 10mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover oxandrolone 10mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
OXANDROLONE 2.5MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover OXANDROLONE 2.5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
OXAPROZIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXAPROZIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
oxazepam 10 mg capsule ![Compare how all Medicare Part D PDP plans in PA cover oxazepam 10 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Oxazepam 15mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Oxazepam 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
oxazepam 30 mg capsule ![Compare how all Medicare Part D PDP plans in PA cover oxazepam 30 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXCARBAZEPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXCARBAZEPINE 300MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 300MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXCARBAZEPINE 600MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 600MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXECTA 7.5mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OXECTA 7.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
OXISTAT 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover OXISTAT 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXISTAT 1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover OXISTAT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXSORALEN 1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover OXSORALEN 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
OXSORALEN-ULTRA 10MG CAP ![Compare how all Medicare Part D PDP plans in PA cover OXSORALEN-ULTRA 10MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
OXTELLAR XR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXTELLAR XR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXTELLAR XR 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXTELLAR XR 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXTELLAR XR 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXTELLAR XR 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
OXYBUTYNIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Oxybutynin Chloride 10mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTENDED R ![Compare how all Medicare Part D PDP plans in PA cover Oxybutynin Chloride 10mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTENDED R.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Oxybutynin Chloride 5mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTENDED RE ![Compare how all Medicare Part D PDP plans in PA cover Oxybutynin Chloride 5mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTENDED RE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Oxybutynin Chloride 5mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Oxybutynin Chloride 5mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:372 /31Days |
OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:372 /31Days |
OXYCODONE HCL 100 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 100 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:180 /31Days |
OXYCODONE HCL 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
OXYCODONE HCL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
OXYCODONE HCL 5 MG/5 ML Solution ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5 MG/5 ML Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:5600 /31Days |
OXYCODONE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
OXYCODONE HCL ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OXYCODONE HCL ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OXYCODONE HCL ER 80 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL ER 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:372 /31Days |
OXYCODONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
OXYCODONE HYDROCHLORIDE 20mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HYDROCHLORIDE 20mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
Oxycodone Hydrochloride and Aspirin 325; 4.8355mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Oxycodone Hydrochloride and Aspirin 325; 4.8355mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:372 /31Days |
OXYCODONE-IBUPROFEN 5-400 TAB ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE-IBUPROFEN 5-400 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
OxyContin 10mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OxyContin 15mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OxyContin 20mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 20mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OxyContin 30mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 30mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OxyContin 40mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 40mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OxyContin 60mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
OxyContin 80mg/1 ![Compare how all Medicare Part D PDP plans in PA cover OxyContin 80mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:100 /31Days |
oxymorphone hcl er 10 mg tab ![Compare how all Medicare Part D PDP plans in PA cover oxymorphone hcl er 10 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
oxymorphone hcl er 20 mg tab ![Compare how all Medicare Part D PDP plans in PA cover oxymorphone hcl er 20 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
oxymorphone hcl er 30 mg tab ![Compare how all Medicare Part D PDP plans in PA cover oxymorphone hcl er 30 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
oxymorphone hcl er 40 mg tab ![Compare how all Medicare Part D PDP plans in PA cover oxymorphone hcl er 40 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
oxymorphone hcl er 5 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover oxymorphone hcl er 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYMORPHONE HYDROCHLORIDE 10MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HYDROCHLORIDE 10MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
Oxymorphone hydrochloride 15mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Oxymorphone hydrochloride 15mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
OXYMORPHONE HYDROCHLORIDE 5MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HYDROCHLORIDE 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:186 /31Days |
Oxymorphone hydrochloride 7.5mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Oxymorphone hydrochloride 7.5mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P Q:100 /31Days |
OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in PA cover OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |