2015 Medicare Part D Plan Formulary Information |
Security Blue Standard (HMO) (H3957-003-0)
Benefit Details
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The Security Blue Standard (HMO) (H3957-003-0) Formulary Drugs Starting with the Letter P in FAYETTE County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $205.00 Deductible: $0 |
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PACERONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PACERONE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PACERONE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PACERONE 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PACERONE 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD ![Compare how all Medicare Part D PDP plans in PA cover PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PAMELOR 10mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PAMELOR 10mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAMELOR 25mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PAMELOR 25mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAMELOR 50mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PAMELOR 50mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAMELOR 75mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PAMELOR 75mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAMIDRONATE 60MG/10ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PAMIDRONATE 60MG/10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD.](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 |
PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
PAMINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PAMINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAMINE FORTE 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PAMINE FORTE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PANCREAZE 10,500 UNIT CAP DR ![Compare how all Medicare Part D PDP plans in PA cover PANCREAZE 10,500 UNIT CAP DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PANCREAZE 16,800 UNIT CAP DR ![Compare how all Medicare Part D PDP plans in PA cover PANCREAZE 16,800 UNIT CAP DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PANCREAZE 21,000 UNIT CAP DR ![Compare how all Medicare Part D PDP plans in PA cover PANCREAZE 21,000 UNIT CAP DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PANCREAZE 4,200 UNIT CAP DR ![Compare how all Medicare Part D PDP plans in PA cover PANCREAZE 4,200 UNIT CAP DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Pandel 1mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Pandel 1mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PANRETIN 0.1% GEL 60GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover PANRETIN 0.1% GEL 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Pantoprazole 40mg/1 90 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Pantoprazole 40mg/1 90 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE.](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 |
Parafon Forte DSC 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Parafon Forte DSC 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PARICALCITOL 1 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in PA cover PARICALCITOL 1 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | P |
PARICALCITOL 2 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in PA cover PARICALCITOL 2 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | P |
PARICALCITOL 2 MCG/ML VIAL [Zemplar] ![Compare how all Medicare Part D PDP plans in PA cover PARICALCITOL 2 MCG/ML VIAL [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PARICALCITOL 4 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in PA cover PARICALCITOL 4 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | P |
PARICALCITOL 5 MCG/ML VIAL [Zemplar] ![Compare how all Medicare Part D PDP plans in PA cover PARICALCITOL 5 MCG/ML VIAL [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PARNATE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PARNATE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAROMOMYCIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PAROMOMYCIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Paroxetine 40mg/1 500 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Paroxetine 40mg/1 500 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PAROXETINE FILM COATED 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PAROXETINE FILM COATED 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PAROXETINE HCL TABLET 24 12.5MG ![Compare how all Medicare Part D PDP plans in PA cover PAROXETINE HCL TABLET 24 12.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAROXETINE HCL TABLET 24 25MG ![Compare how all Medicare Part D PDP plans in PA cover PAROXETINE HCL TABLET 24 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Paroxetine Hydrochloride 37.5mg/1 30 BOTTLE in 1 BOTTLE / 30 TABLET, FILM COATED, EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover Paroxetine Hydrochloride 37.5mg/1 30 BOTTLE in 1 BOTTLE / 30 TABLET, FILM COATED, EXTENDED RELEASE .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PAROXETINE HYDROCHLORIDE TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in PA cover PAROXETINE HYDROCHLORIDE TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PAROXETINE TABLETS 30MG 90 BOT ![Compare how all Medicare Part D PDP plans in PA cover PAROXETINE TABLETS 30MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PASER GRANULES 4GM PACKET ![Compare how all Medicare Part D PDP plans in PA cover PASER GRANULES 4GM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PATADAY 0.2% DROPS ![Compare how all Medicare Part D PDP plans in PA cover PATADAY 0.2% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PATANASE 665ug/1 240 SPRAY, METERED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PATANASE 665ug/1 240 SPRAY, METERED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PATANOL 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PATANOL 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL 25mg/1 ![Compare how all Medicare Part D PDP plans in PA cover PAXIL 25mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL CR TABLETS CONTROLLED RELEASE 12.5 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL CR TABLETS CONTROLLED RELEASE 12.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL CR TABLETS EXTENDED RELEASE 37.5 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL CR TABLETS EXTENDED RELEASE 37.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAXIL ORAL SUSPENSION 10 MG/5ML ![Compare how all Medicare Part D PDP plans in PA cover PAXIL ORAL SUSPENSION 10 MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL TABLETS 20 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL TABLETS 20 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL TABLETS 30 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL TABLETS 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAXIL TABLETS 40 MG ![Compare how all Medicare Part D PDP plans in PA cover PAXIL TABLETS 40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PAZEO 0.7% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PAZEO 0.7% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PCE 333 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PCE 333 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PCE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PCE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEDVAXHIB VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PA cover PEDVAXHIB VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEG-3350 and Electrolytes 236; 2.97; 6.74; 5.86; 22.74g/2L; g/2L; g/2L; g/2L; g/2L 4 L in 1 JUG ![Compare how all Medicare Part D PDP plans in PA cover PEG-3350 and Electrolytes 236; 2.97; 6.74; 5.86; 22.74g/2L; g/2L; g/2L; g/2L; g/2L 4 L in 1 JUG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PEGANONE 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEGANONE 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in PA cover Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGASYS INJECTION ![Compare how all Medicare Part D PDP plans in PA cover PEGASYS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGASYS PROCLICK 135 MCG/0.5 ![Compare how all Medicare Part D PDP plans in PA cover PEGASYS PROCLICK 135 MCG/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGASYS PROCLICK 180 MCG/0.5 ![Compare how all Medicare Part D PDP plans in PA cover PEGASYS PROCLICK 180 MCG/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGINTRON 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in PA cover PEGINTRON 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGINTRON 120 MCG KIT ![Compare how all Medicare Part D PDP plans in PA cover PEGINTRON 120 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PegIntron 120ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover PegIntron 120ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGINTRON 150 MCG KIT ![Compare how all Medicare Part D PDP plans in PA cover PEGINTRON 150 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PegIntron 150ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover PegIntron 150ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PegIntron 50ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover PegIntron 50ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PEGINTRON 80 MCG KIT ![Compare how all Medicare Part D PDP plans in PA cover PEGINTRON 80 MCG KIT.](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 |
PegIntron 80ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover PegIntron 80ug/0.5mL 1 CARTRIDGE per CARTON / 0.5 mL in 1 CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PENICILLIN G POTASSIUM FOR INJECTION 5000000UNIT/VIAL ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN G POTASSIUM FOR INJECTION 5000000UNIT/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PENICILLIN G PROCAINE 1200000UNT 2ML CTG ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN G PROCAINE 1200000UNT 2ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Penicillin V Potassium 125mg/5mL 200 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Penicillin V Potassium 125mg/5mL 200 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Penicillin V Potassium 250mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Penicillin V Potassium 250mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN V POTASSIUM 250MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PENICILLIN V POTASSIUM 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PENICILLIN V POTASSIUM 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PENNSAID 2% PUMP ![Compare how all Medicare Part D PDP plans in PA cover PENNSAID 2% PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENTAM 300 INJ 300MG ![Compare how all Medicare Part D PDP plans in PA cover PENTAM 300 INJ 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PENTASA 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover PENTASA 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PENTASA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PENTASA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Pentazocine Hydrochloride and Naloxone Hydrochloride 0.5; 50mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Pentazocine Hydrochloride and Naloxone Hydrochloride 0.5; 50mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PENTOXIFYLLINE 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover PENTOXIFYLLINE 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PEPCID 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEPCID 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEPCID SOLUTION 40MG 24 X 400MG BOT ![Compare how all Medicare Part D PDP plans in PA cover PEPCID SOLUTION 40MG 24 X 400MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PERCOCET 10/325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERCOCET 10/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:372 /31Days |
PERCOCET 2.5/325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERCOCET 2.5/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:372 /31Days |
PERCOCET 7.5/325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERCOCET 7.5/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:372 /31Days |
PERCOCET TABLET 5-325MG ![Compare how all Medicare Part D PDP plans in PA cover PERCOCET TABLET 5-325MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:372 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERCODAN TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERCODAN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PERFOROMIST 20MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in PA cover PERFOROMIST 20MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
Perindopril Erbumine 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Perindopril Erbumine 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Perindopril Erbumine 4mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Perindopril Erbumine 4mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Perindopril Erbumine 8mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Perindopril Erbumine 8mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PERIOGARD 0.12% ORAL RINSE ![Compare how all Medicare Part D PDP plans in PA cover PERIOGARD 0.12% ORAL RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PERJETA 420 MG/14 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PERJETA 420 MG/14 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Permethrin 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Permethrin 50mg/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 |
$12.00 | $30.00 | None |
Perphenazine 16mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Perphenazine 16mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PERPHENAZINE TABLETS 4MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover PERPHENAZINE TABLETS 4MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PERPHENAZINE TABLETS 8MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover PERPHENAZINE TABLETS 8MG 100 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 |
PERPHENAZINE TABLETS USP 2MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover PERPHENAZINE TABLETS USP 2MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PERSANTINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERSANTINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PERSANTINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERSANTINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PERSANTINE 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PERSANTINE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PERTZYE DR 16,000 UNITS CAPS ![Compare how all Medicare Part D PDP plans in PA cover PERTZYE DR 16,000 UNITS CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PERTZYE DR 8,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PERTZYE DR 8,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEXEVA 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEXEVA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEXEVA 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEXEVA 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEXEVA 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEXEVA 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PEXEVA 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PEXEVA 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Pfizerpen 5000000[iU]/1 10 VIAL in 1 CARTON / 1 POWDER, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Pfizerpen 5000000[iU]/1 10 VIAL in 1 CARTON / 1 POWDER, FOR SOLUTION in 1 VIAL.](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 |
Phenadoz 12.5 mg Suppository ![Compare how all Medicare Part D PDP plans in PA cover Phenadoz 12.5 mg Suppository.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Phenergan 12.5 mg suppository ![Compare how all Medicare Part D PDP plans in PA cover Phenergan 12.5 mg suppository.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Phenergan 25 mg suppository ![Compare how all Medicare Part D PDP plans in PA cover Phenergan 25 mg suppository.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENERGAN 25 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PHENERGAN 25 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Phenergan 50 mg suppository ![Compare how all Medicare Part D PDP plans in PA cover Phenergan 50 mg suppository.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENERGAN 50 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PHENERGAN 50 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Phenobarbital 100mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Phenobarbital 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Phenobarbital 15mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Phenobarbital 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENOBARBITAL 16.2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PHENOBARBITAL 16.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENOBARBITAL 20 MG/5 ML ELIX ![Compare how all Medicare Part D PDP plans in PA cover PHENOBARBITAL 20 MG/5 ML ELIX.](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 |
Phenobarbital 30mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Phenobarbital 30mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENOBARBITAL 32.4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PHENOBARBITAL 32.4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Phenobarbital 60mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Phenobarbital 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENOBARBITAL 64.8 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PHENOBARBITAL 64.8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENOBARBITAL 97.2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PHENOBARBITAL 97.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENYTEK 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PHENYTEK 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PHENYTEK 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PHENYTEK 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
phenytoin 50 mg tablet chew ![Compare how all Medicare Part D PDP plans in PA cover phenytoin 50 mg tablet chew.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT ![Compare how all Medicare Part D PDP plans in PA cover PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENYTOIN SOD EXT 200 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover PHENYTOIN SOD EXT 200 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHENYTOIN SODIUM 100MG /2ML INJECTION ![Compare how all Medicare Part D PDP plans in PA cover PHENYTOIN SODIUM 100MG /2ML INJECTION.](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 |
PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PHOSLO 667MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PHOSLO 667MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Phoslyra 667mg/5mL 1 BOTTLE per CARTON / 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Phoslyra 667mg/5mL 1 BOTTLE per CARTON / 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PHOSPHOLINE IODIDE 0.125% 6.25MG ![Compare how all Medicare Part D PDP plans in PA cover PHOSPHOLINE IODIDE 0.125% 6.25MG .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PHYSIOLYTE SOLUTION FOR IRRIGATION ![Compare how all Medicare Part D PDP plans in PA cover PHYSIOLYTE SOLUTION FOR IRRIGATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PHYSIOSOL IRRIGATION SOL ![Compare how all Medicare Part D PDP plans in PA cover PHYSIOSOL IRRIGATION SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PICATO 0.015% GEL ![Compare how all Medicare Part D PDP plans in PA cover PICATO 0.015% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PICATO 0.05% GEL ![Compare how all Medicare Part D PDP plans in PA cover PICATO 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PILOCARPINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PILOCARPINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PILOCARPINE 2% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PILOCARPINE 2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PILOCARPINE 4% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PILOCARPINE 4% EYE DROPS.](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 |
PILOCARPINE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PILOCARPINE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pilocarpine Hydrochloride 7.5mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Pilocarpine Hydrochloride 7.5mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PIMTREA 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in PA cover PIMTREA 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PINDOLOL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PINDOLOL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PINDOLOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PINDOLOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
pioglitaz-glimepir 30-2 mg tab ![Compare how all Medicare Part D PDP plans in PA cover pioglitaz-glimepir 30-2 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
pioglitaz-glimepir 30-4 mg tab ![Compare how all Medicare Part D PDP plans in PA cover pioglitaz-glimepir 30-4 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
pioglitazone hcl 15 mg tablet [Actos] ![Compare how all Medicare Part D PDP plans in PA cover pioglitazone hcl 15 mg tablet [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
pioglitazone hcl 30 mg tablet [Actos] ![Compare how all Medicare Part D PDP plans in PA cover pioglitazone hcl 30 mg tablet [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
pioglitazone hcl 45 mg tablet [Actos] ![Compare how all Medicare Part D PDP plans in PA cover pioglitazone hcl 45 mg tablet [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PIOGLITAZONE-METFORMIN 15-500 ![Compare how all Medicare Part D PDP plans in PA cover PIOGLITAZONE-METFORMIN 15-500.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIOGLITAZONE-METFORMIN 15-850 ![Compare how all Medicare Part D PDP plans in PA cover PIOGLITAZONE-METFORMIN 15-850.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PIPERACILLIN 200 MG/ML / TAZOBACTAM 25 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PIPERACILLIN 200 MG/ML / TAZOBACTAM 25 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Piperacillin and Tazobactam 4; 0.5g/1; g/1 10 VIAL, SINGLE-USE per CARTON / 1 INJECTION, POWDER, L ![Compare how all Medicare Part D PDP plans in PA cover Piperacillin and Tazobactam 4; 0.5g/1; g/1 10 VIAL, SINGLE-USE per CARTON / 1 INJECTION, POWDER, L.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pirmella 1-35-28 tablet ![Compare how all Medicare Part D PDP plans in PA cover Pirmella 1-35-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PIROXICAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PIROXICAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Piroxicam 20mg/1 500 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Piroxicam 20mg/1 500 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PLAQUENIL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PLAQUENIL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PLASMA-LYTE 148 IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PLASMA-LYTE 148 IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PLASMA-LYTE 56/DEXTROSE 5% ![Compare how all Medicare Part D PDP plans in PA cover PLASMA-LYTE 56/DEXTROSE 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML; ![Compare how all Medicare Part D PDP plans in PA cover PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PLAVIX 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PLAVIX 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PLAVIX TABLETS 300MG ![Compare how all Medicare Part D PDP plans in PA cover PLAVIX TABLETS 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PLEGRIDY 125 MCG/0.5 ML PEN ![Compare how all Medicare Part D PDP plans in PA cover PLEGRIDY 125 MCG/0.5 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PLEGRIDY 125 MCG/0.5 ML SYRING ![Compare how all Medicare Part D PDP plans in PA cover PLEGRIDY 125 MCG/0.5 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PLEGRIDY PEN INJ STARTER PACK ![Compare how all Medicare Part D PDP plans in PA cover PLEGRIDY PEN INJ STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PLETAL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PLETAL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PLETAL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PLETAL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PODOFILOX 0.5% TOPICAL TUBEX ![Compare how all Medicare Part D PDP plans in PA cover PODOFILOX 0.5% TOPICAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT) ![Compare how all Medicare Part D PDP plans in PA cover POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
polymyxin b 5000001/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover polymyxin b 5000001/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1% ![Compare how all Medicare Part D PDP plans in PA cover POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POLYTRIM EYE DROP ![Compare how all Medicare Part D PDP plans in PA cover POLYTRIM EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POMALYST 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover POMALYST 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
POMALYST 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover POMALYST 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
POMALYST 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover POMALYST 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
POMALYST 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover POMALYST 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PONSTEL 250 MG KAPSEALS ![Compare how all Medicare Part D PDP plans in PA cover PONSTEL 250 MG KAPSEALS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PORTIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PA cover PORTIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225% ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE 750MG EXTENDED RELEASE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE 750MG EXTENDED RELEASE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CHLORIDE ER CAPSULES 10MEQ ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE ER CAPSULES 10MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
POTASSIUM CHLORIDE ER CPCR 8MEQ ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE ER CPCR 8MEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in PA cover Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.33g/100mL; g/100mL; g/100mL 12 CONTAI ![Compare how all Medicare Part D PDP plans in PA cover Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.33g/100mL; g/100mL; g/100mL 12 CONTAI.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.45g/100mL; g/100mL; g/100mL 12 CONTAI ![Compare how all Medicare Part D PDP plans in PA cover Potassium Chloride in Dextrose and Sodium Chloride 5; 0.15; 0.45g/100mL; g/100mL; g/100mL 12 CONTAI.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i ![Compare how all Medicare Part D PDP plans in PA cover Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Chloride in Lactated Ringers and Dextrose 20; 5; 179; 600; 310mg/100mL; g/100mL; mg/100mL ![Compare how all Medicare Part D PDP plans in PA cover Potassium Chloride in Lactated Ringers and Dextrose 20; 5; 179; 600; 310mg/100mL; g/100mL; mg/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION.](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 |
POTASSIUM CHLORIDE INJECTION 10MEQ/100ML ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE INJECTION 10MEQ/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE INJECTION 20 MEQ/100ML ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE INJECTION 20 MEQ/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CHLORIDE INJECTION 40 MEQ/100ML ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CHLORIDE INJECTION 40 MEQ/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CITRATE ER 10 MEQ TB ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CITRATE ER 10 MEQ TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CITRATE ER 15 MEQ TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CITRATE ER 15 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CITRATE ER 5 MEQ TAB ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CITRATE ER 5 MEQ TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CITRATE ER 8 MEQ TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CITRATE ER 8 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Potassium Cl 10% (20 MEQ/15 ML) ![Compare how all Medicare Part D PDP plans in PA cover Potassium Cl 10% (20 MEQ/15 ML).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium cl 2 meq/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Potassium cl 2 meq/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Potassium Cl 20% (40 MEQ/15 ML) ![Compare how all Medicare Part D PDP plans in PA cover Potassium Cl 20% (40 MEQ/15 ML).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
POTASSIUM CL ER 20 MEQ TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTASSIUM CL ER 20 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTIGA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTIGA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
POTIGA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTIGA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
POTIGA 400 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTIGA 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
POTIGA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover POTIGA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRADAXA 150mg/1 1 BOTTLE per CARTON / 60 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PRADAXA 150mg/1 1 BOTTLE per CARTON / 60 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PRADAXA 75mg/1 1 BOTTLE per CARTON / 60 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PRADAXA 75mg/1 1 BOTTLE per CARTON / 60 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Pramipexole Dihydrochloride 0.125mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pramipexole Dihydrochloride 0.125mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pramipexole Dihydrochloride 0.25mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pramipexole Dihydrochloride 0.25mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pramipexole Dihydrochloride 0.5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pramipexole Dihydrochloride 0.5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PRAMIPEXOLE DIHYDROCHLORIDE 0.75MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover PRAMIPEXOLE DIHYDROCHLORIDE 0.75MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pramipexole Dihydrochloride 1.5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pramipexole Dihydrochloride 1.5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Pramipexole Dihydrochloride 1mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pramipexole Dihydrochloride 1mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PRANDIMET 1MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRANDIMET 1MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PRANDIMET 2MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRANDIMET 2MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Prandin 0.5mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Prandin 0.5mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Prandin 1mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Prandin 1mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Prandin 2mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Prandin 2mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRAVACHOL 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRAVACHOL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRAVACHOL 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRAVACHOL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRAVACHOL 80MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRAVACHOL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRAVASTATIN SODIUM 20MG TABLET 500 BOT ![Compare how all Medicare Part D PDP plans in PA cover PRAVASTATIN SODIUM 20MG TABLET 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRAVASTATIN SODIUM 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover PRAVASTATIN SODIUM 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Pravastatin Sodium 80mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Pravastatin Sodium 80mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRAVASTATIN SODIUM TABLETS 10MG 90 BOT ![Compare how all Medicare Part D PDP plans in PA cover PRAVASTATIN SODIUM TABLETS 10MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRAZOSIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PRAZOSIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRAZOSIN HCL 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PRAZOSIN HCL 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRAZOSIN HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PRAZOSIN HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PRECOSE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRECOSE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRECOSE TABLETS 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover PRECOSE TABLETS 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRECOSE TABLETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover PRECOSE TABLETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRED FORTE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PRED FORTE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRED MILD 0.12% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PRED MILD 0.12% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRED-G S.O.P. EYE OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover PRED-G S.O.P. EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREDNICARBATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover PREDNICARBATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNICARBATE 1 MG/ML TOPICAL CREAM ![Compare how all Medicare Part D PDP plans in PA cover PREDNICARBATE 1 MG/ML TOPICAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prednisolone odt 10 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Prednisolone odt 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prednisolone odt 15 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Prednisolone odt 15 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prednisolone odt 30 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Prednisolone odt 30 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNISOLONE SOD 1% EYE DROP ![Compare how all Medicare Part D PDP plans in PA cover PREDNISOLONE SOD 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNISOLONE SOD PH 25 MG/5 ML ![Compare how all Medicare Part D PDP plans in PA cover PREDNISOLONE SOD PH 25 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PREDNISOLONE SODIUM PHOSPHATE 5MG /5ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PREDNISOLONE SODIUM PHOSPHATE 5MG /5ML ORAL SOLUTION.](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 |
PREDNISONE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 5MG/5ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 5MG/5ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PREDNISONE 5MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PREDNISONE 5MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prefest 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Prefest 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREGNYL INJ 10000UNT ![Compare how all Medicare Part D PDP plans in PA cover PREGNYL INJ 10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
Premarin 0.3mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Premarin 0.3mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMARIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREMARIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Premarin 0.625mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Premarin 0.625mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Premarin 0.625mg/g ![Compare how all Medicare Part D PDP plans in PA cover Premarin 0.625mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PREMARIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREMARIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Premarin 1.25mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Premarin 1.25mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PREMARIN 25MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover PREMARIN 25MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PREMASOL 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PREMASOL 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
PREMASOL 6% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PREMASOL 6% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PREMPHASE 0.625-5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREMPHASE 0.625-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREMPRO 0.3 MG-1.5 MG TABLET #28 EA ![Compare how all Medicare Part D PDP plans in PA cover PREMPRO 0.3 MG-1.5 MG TABLET #28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREMPRO 0.45-1.5 MG TABLET 28 EA ![Compare how all Medicare Part D PDP plans in PA cover PREMPRO 0.45-1.5 MG TABLET 28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMPRO 0.625-5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREMPRO 0.625-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Prempro 0.625; 2.5mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, SUGAR COATED per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Prempro 0.625; 2.5mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, SUGAR COATED per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREPOPIK POWDER PACKET ![Compare how all Medicare Part D PDP plans in PA cover PREPOPIK POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREVACID CAPSULES DELAYED RELEASE 15 MG ![Compare how all Medicare Part D PDP plans in PA cover PREVACID CAPSULES DELAYED RELEASE 15 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREVACID CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in PA cover PREVACID CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREVACID SOLUTAB TABLETS DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in PA cover PREVACID SOLUTAB TABLETS DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREVALITE POW 4GM ![Compare how all Medicare Part D PDP plans in PA cover PREVALITE POW 4GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Previfem 6 BLISTER PACK per BLISTER PACK / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Previfem 6 BLISTER PACK per BLISTER PACK / 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 |
PREVPAC (TRIPLE THERAPY) KIT 30;500;500MG;MG;MG; 14 PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover PREVPAC (TRIPLE THERAPY) KIT 30;500;500MG;MG;MG; 14 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PREZCOBIX 800 MG-150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREZCOBIX 800 MG-150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREZISTA 100 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover PREZISTA 100 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PREZISTA 150MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover PREZISTA 150MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PREZISTA 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PREZISTA 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PREZISTA TABLET 600MG ![Compare how all Medicare Part D PDP plans in PA cover PREZISTA TABLET 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PREZISTA TABLET 75MG ![Compare how all Medicare Part D PDP plans in PA cover PREZISTA TABLET 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PRIFTIN 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRIFTIN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRILOSEC 10mg/1 30 GRANULE, DELAYED RELEASE in 1 CARTON ![Compare how all Medicare Part D PDP plans in PA cover PRILOSEC 10mg/1 30 GRANULE, DELAYED RELEASE in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRILOSEC 2.5mg/1 30 GRANULE, DELAYED RELEASE in 1 CARTON ![Compare how all Medicare Part D PDP plans in PA cover PRILOSEC 2.5mg/1 30 GRANULE, DELAYED RELEASE in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRILOSEC 20mg/1 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PRILOSEC 20mg/1 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRILOSEC 40mg DELAYED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PRILOSEC 40mg DELAYED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRILOSEC DR 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PRILOSEC DR 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRIMAQUINE 26.3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRIMAQUINE 26.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PRIMAXIN IV 250MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover PRIMAXIN IV 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS ![Compare how all Medicare Part D PDP plans in PA cover PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Primidone 250mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Primidone 250mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Primidone 50mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Primidone 50mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PRIMLEV 10-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRIMLEV 10-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:403 /31Days |
PRIMLEV 5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRIMLEV 5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:403 /31Days |
PRIMLEV 7.5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRIMLEV 7.5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:403 /31Days |
PRIMSOL 50MG/5ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PRIMSOL 50MG/5ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRINIVIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRINIVIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRINIVIL 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRINIVIL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRINIVIL 5MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover PRINIVIL 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PRISTIQ 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in PA cover PRISTIQ 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PRISTIQ ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PRISTIQ ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
Pristiq Extended-Release 50mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Pristiq Extended-Release 50mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PRIVIGEN 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover PRIVIGEN 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROAIR HFA 90 MCG INHALER ![Compare how all Medicare Part D PDP plans in PA cover PROAIR HFA 90 MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PROAIR RESPICLICK INHAL POWDER ![Compare how all Medicare Part D PDP plans in PA cover PROAIR RESPICLICK INHAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PROBENECID 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROBENECID 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROBENECID/COLCHICINE 0.5MG/500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROBENECID/COLCHICINE 0.5MG/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCAINAMIDE 100MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCAINAMIDE 100MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCAINAMIDE 500MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCAINAMIDE 500MG/ML VIAL.](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 |
ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0 ![Compare how all Medicare Part D PDP plans in PA cover ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PROCARDIA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROCARDIA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROCARDIA XL 30MG TABLET (300 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROCARDIA XL 30MG TABLET (300 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROCARDIA XL 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover PROCARDIA XL 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROCARDIA XL 90MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover PROCARDIA XL 90MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROCENTRA 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover PROCENTRA 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prochlorperazine 10 mg/2 ml vl ![Compare how all Medicare Part D PDP plans in PA cover Prochlorperazine 10 mg/2 ml vl.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Prochlorperazine Maleate 5mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Prochlorperazine Maleate 5mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in PA cover PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCRIT 10000U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT 10000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT 2000U/ML VIAL 6 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
PROCRIT 3,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT 3,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
PROCRIT 4,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT 4,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
PROCRIT 40000U/ML VIAL PR ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT 40000U/ML VIAL PR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY ![Compare how all Medicare Part D PDP plans in PA cover PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
procto-pak 1% cream ![Compare how all Medicare Part D PDP plans in PA cover procto-pak 1% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCTOSOL-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in PA cover PROCTOSOL-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
proctozone-hc 2.5% cream ![Compare how all Medicare Part D PDP plans in PA cover proctozone-hc 2.5% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROCYSBI DR 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROCYSBI DR 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROCYSBI DR 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROCYSBI DR 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROGESTERONE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROGESTERONE 100 MG CAPSULE.](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 |
PROGESTERONE 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROGESTERONE 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Proglycem 50mg/mL 1 BOTTLE, DROPPER in 1 BOX / 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in PA cover Proglycem 50mg/mL 1 BOTTLE, DROPPER in 1 BOX / 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PROGRAF 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROGRAF 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PROGRAF 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROGRAF 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PROGRAF 5mg/1 1 BOTTLE per CARTON / 100 CAPSULE, GELATIN COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover PROGRAF 5mg/1 1 BOTTLE per CARTON / 100 CAPSULE, GELATIN COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROGRAF 5MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in PA cover PROGRAF 5MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
PROLASTIN-C ![Compare how all Medicare Part D PDP plans in PA cover PROLASTIN-C .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROLENSA 0.07% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PROLENSA 0.07% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROLEUKIN 22 MILLION UNIT VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROLEUKIN 22 MILLION UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
PROLIA 60MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in PA cover PROLIA 60MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:1 /180Days |
PROMACTA 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROMACTA 12.5 MG TABLET.](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 |
PROMACTA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROMACTA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROMACTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROMACTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROMACTA 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROMACTA 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
PROMETHAZINE 50 MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE 50 MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HCL 25MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HCL 25MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HCL 6.25MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HCL 6.25MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HYDROCHLORIDE 12.5mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HYDROCHLORIDE 12.5mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HYDROCHLORIDE 25mg/mL 25 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HYDROCHLORIDE 25mg/mL 25 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX.](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 |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHAZINE VC SYRUP ![Compare how all Medicare Part D PDP plans in PA cover PROMETHAZINE VC SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHEGAN 25MG SUPP ![Compare how all Medicare Part D PDP plans in PA cover PROMETHEGAN 25MG SUPP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETHEGAN 50MG SUPPOS ![Compare how all Medicare Part D PDP plans in PA cover PROMETHEGAN 50MG SUPPOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROMETRIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROMETRIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROMETRIUM 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROMETRIUM 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Propafenone HCl 150mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Propafenone HCl 150mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROPAFENONE HCL 225MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPAFENONE HCL 225MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROPAFENONE HCL 300MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROPAFENONE HCL 300MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Propafenone Hydrochloride 225mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Propafenone Hydrochloride 225mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE.](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 |
PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROPARACAINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover PROPARACAINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Propranolol 1mg/mL 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Propranolol 1mg/mL 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL 60MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL ER 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL ER 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL ER 160 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL ER 160 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL HCL 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL HCL 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL HCL TABLET USP 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL HCL TABLET USP 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL HCL TABLET USP 40MG (1000 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL HCL TABLET USP 40MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Propranolol Hydrochloride 60mg/1 1000 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Propranolol Hydrochloride 60mg/1 1000 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Propranolol Hydrochloride 80mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Propranolol Hydrochloride 80mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL/HCTZ 40/25 TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL/HCTZ 40/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPRANOLOL/HCTZ 80/25 TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPRANOLOL/HCTZ 80/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
PROPYLTHIOURACIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROPYLTHIOURACIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROQUAD 0.5 VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROQUAD 0.5 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
PROSCAR TABLETS 5MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover PROSCAR TABLETS 5MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROSOL 20% INJECTION ![Compare how all Medicare Part D PDP plans in PA cover PROSOL 20% INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PROTONIX 20MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover PROTONIX 20MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROTONIX 40MG SUSP FOR RECON DELAYED REL. IN A PACKET ![Compare how all Medicare Part D PDP plans in PA cover PROTONIX 40MG SUSP FOR RECON DELAYED REL. IN A PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROTONIX 40MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover PROTONIX 40MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROTONIX I.V. 40mg/10mL 10 CARTON in 1 PACKAGE / 1 VIAL per CARTON / 40 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover PROTONIX I.V. 40mg/10mL 10 CARTON in 1 PACKAGE / 1 VIAL per CARTON / 40 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROTOPIC 0.03% OINTMENT 100GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover PROTOPIC 0.03% OINTMENT 100GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROTOPIC 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover PROTOPIC 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROTRIPTYLINE HYDROCHLORIDE 10MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover PROTRIPTYLINE HYDROCHLORIDE 10MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG ![Compare how all Medicare Part D PDP plans in PA cover PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PROVENTIL HFA INHALER 90MCG AE ![Compare how all Medicare Part D PDP plans in PA cover PROVENTIL HFA INHALER 90MCG AE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROVERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROVERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROVERA 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover PROVERA 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROVERA 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROVERA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROVIGIL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROVIGIL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days |
PROVIGIL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PROVIGIL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P Q:31 /31Days |
PROZAC 10MG PULVULE ![Compare how all Medicare Part D PDP plans in PA cover PROZAC 10MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Prozac 20mg/1 100 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Prozac 20mg/1 100 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROZAC 40MG PULVULE ![Compare how all Medicare Part D PDP plans in PA cover PROZAC 40MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PROZAC WEEKLY 90MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PROZAC WEEKLY 90MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Prudoxin 5% cream ![Compare how all Medicare Part D PDP plans in PA cover Prudoxin 5% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
PULMICORT .25MG/2ML RESPULE ![Compare how all Medicare Part D PDP plans in PA cover PULMICORT .25MG/2ML RESPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION ![Compare how all Medicare Part D PDP plans in PA cover PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in PA cover PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in PA cover PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PULMICORT RESPULES 0.5mg/2mL 6 POUCH per CARTON / 5 AMPULE in 1 POUCH / 2 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in PA cover PULMICORT RESPULES 0.5mg/2mL 6 POUCH per CARTON / 5 AMPULE in 1 POUCH / 2 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PULMOZYME 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover PULMOZYME 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
PURIXAN 20 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover PURIXAN 20 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PYLERA CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover PYLERA CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
PYRAZINAMIDE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover PYRAZINAMIDE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Pyridostigmine br 60 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Pyridostigmine br 60 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |