2015 Medicare Part D Plan Formulary Information |
SecureCare SNP (HMO SNP) (H5151-007-0)
Benefit Details
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The SecureCare SNP (HMO SNP) (H5151-007-0) Formulary Drugs Starting with the Letter S in WAYNE County, WV: CMS MA Region 6 which includes: WV Plan Monthly Premium: $32.70 Deductible: $320 |
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SAIZEN 5 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SAIZEN 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SAIZEN 8.8 MG CLICK.EASY CARTG ![Compare how all Medicare Part D PDP plans in WV cover SAIZEN 8.8 MG CLICK.EASY CARTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SAIZEN 8.8 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SAIZEN 8.8 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in WV cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P |
SANDOSTATIN LAR 10MG KIT ![Compare how all Medicare Part D PDP plans in WV cover SANDOSTATIN LAR 10MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SANDOSTATIN LAR 20MG KIT ![Compare how all Medicare Part D PDP plans in WV cover SANDOSTATIN LAR 20MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SANDOSTATIN LAR 30MG KIT ![Compare how all Medicare Part D PDP plans in WV cover SANDOSTATIN LAR 30MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SAPHRIS 10 MG TAB SL BLK CHERY ![Compare how all Medicare Part D PDP plans in WV cover SAPHRIS 10 MG TAB SL BLK CHERY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days |
SAPHRIS 2.5 MG TAB SL BLK CHRY ![Compare how all Medicare Part D PDP plans in WV cover SAPHRIS 2.5 MG TAB SL BLK CHRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SAPHRIS 5 MG TAB SL BLK CHERRY ![Compare how all Medicare Part D PDP plans in WV cover SAPHRIS 5 MG TAB SL BLK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in WV cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:161 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:480 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in WV cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:81 /30Days |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:240 /30Days |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:120 /30Days |
SERTRALINE HYDROCHLORIDE 20MG/ML ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in WV cover SERTRALINE HYDROCHLORIDE 20MG/ML ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WV cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WV cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SHAROBEL 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SHAROBEL 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Signifor .3 mg/mL ![Compare how all Medicare Part D PDP plans in WV cover Signifor .3 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Signifor .6 mg/mL ![Compare how all Medicare Part D PDP plans in WV cover Signifor .6 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
Signifor .9 mg/mL ![Compare how all Medicare Part D PDP plans in WV cover Signifor .9 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
Sildenafil 10 mg/12.5 ml vial ![Compare how all Medicare Part D PDP plans in WV cover Sildenafil 10 mg/12.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SILDENAFIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SILDENAFIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P Q:90 /30Days |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in WV cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
SIMVASTATIN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WV cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in WV cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in WV cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in WV cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sodium Chloride 3g/100mL ![Compare how all Medicare Part D PDP plans in WV cover Sodium Chloride 3g/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Sodium Chloride 900mg/100mL 9 BOTTLE, PLASTIC in 1 CASE / 1500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in WV cover Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM PHENYLBUTYRATE POWDER ![Compare how all Medicare Part D PDP plans in WV cover SODIUM PHENYLBUTYRATE POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
sodium polystyrene sulf pwd ![Compare how all Medicare Part D PDP plans in WV cover sodium polystyrene sulf pwd.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOLTAMOX 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in WV cover SOLTAMOX 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in WV cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
Somatuline Depot 90mg/0.3mL 1 POUCH per CARTON / 1 SYRINGE in 1 POUCH / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WV cover Somatuline Depot 90mg/0.3mL 1 POUCH per CARTON / 1 SYRINGE in 1 POUCH / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SOMAVERT 25 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 25 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SOMAVERT 30 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SOMAVERT 30 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in WV cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
sotalol hydrochloride 160mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover sotalol hydrochloride 160mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SOTYLIZE 5 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover SOTYLIZE 5 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SOVALDI 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SOVALDI 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SPINOSAD 0.9% TOPICAL SUSP ![Compare how all Medicare Part D PDP plans in WV cover SPINOSAD 0.9% TOPICAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in WV cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:30 /30Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:60 /30Days |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in WV cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SSD Cream 10g/1000g 85 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV cover SSD Cream 10g/1000g 85 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STAVUDINE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in WV cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STERILE WATER FOR IRRIGATION ![Compare how all Medicare Part D PDP plans in WV cover STERILE WATER FOR IRRIGATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:84 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in WV cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in WV cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUCRAID 8500[iU]/mL ![Compare how all Medicare Part D PDP plans in WV cover SUCRAID 8500[iU]/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in WV cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sulfadiazine 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Sulfadiazine 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL ![Compare how all Medicare Part D PDP plans in WV cover Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
Sulfamethoxazole and Trimethoprim 800; 160mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Sulfamethoxazole and Trimethoprim 800; 160mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover SULFAMETHOXAZOLE-TRIMETHOPRIM TABLET 400-80MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFAMYLON CREAM 85GM 4 OZ TUBE ![Compare how all Medicare Part D PDP plans in WV cover SULFAMYLON CREAM 85GM 4 OZ TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in WV cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
SUMATRIPTAN 20 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN 20 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:18 /28Days |
SUMATRIPTAN 5 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN 5 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:36 /28Days |
Sumatriptan 6 mg/0.5 ml vial ![Compare how all Medicare Part D PDP plans in WV cover Sumatriptan 6 mg/0.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:16 /28Days |
Sumatriptan Succinate 25mg/1 9 BLISTER PACK per CARTON / 9 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WV cover Sumatriptan Succinate 25mg/1 9 BLISTER PACK per CARTON / 9 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:18 /28Days |
Sumatriptan Succinate 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover Sumatriptan Succinate 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:18 /28Days |
Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WV cover Sumatriptan Succinate 6mg/0.5mL 2 SYRINGE in 1 PACKAGE / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:16 /28Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in WV cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
15% | 15% | Q:18 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUPRAX 100 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 100 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 100MG/5ML SUSPENSION RECONSTITUTED ORAL 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUPRAX 200 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 200 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 200MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUPRAX 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WV cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P |
Surmontil 50mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Surmontil 50mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P |
SUTENT 25mg/1 28 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 25mg/1 28 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:60 /30Days |
SUTENT 37.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 37.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:60 /30Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | P Q:30 /30Days |
SYLATRON 296 MCG KIT 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WV cover SYLATRON 296 MCG KIT 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYLATRON 444 MCG KIT 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WV cover SYLATRON 444 MCG KIT 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYLATRON 888 MCG KIT 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WV cover SYLATRON 888 MCG KIT 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYLVANT 100 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SYLVANT 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in WV cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P Q:10 /30Days |
SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER ![Compare how all Medicare Part D PDP plans in WV cover SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P Q:10 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WV cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P Q:19 /30Days |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WV cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
15% | 15% | P Q:11 /30Days |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |
SYPRINE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover SYPRINE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
15% | 15% | None |