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2015 Medicare Part D and Medicare Advantage Plan Formulary Browser

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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Express Scripts Medicare - Choice (PDP) (S5660-206-0)
Tier 1 (417)
Tier 2 (1631)
Tier 3 (769)
Tier 4 (431)
Tier 5 (364)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2015 Medicare Part D Plan Formulary Information
Express Scripts Medicare - Choice (PDP) (S5660-206-0)
Benefit Details           
The Express Scripts Medicare - Choice (PDP) (S5660-206-0)
Formulary Drugs Starting with the Letter F

in CMS PDP Region 2 which includes: CT MA RI VT
Plan Monthly Premium: $51.00 Deductible: $50 Qualifies for LIS: No
Drugs Starting with Letter F

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
FABRAZYME 35MG VIAL   5 Specialty Tier 31%N/ANone
FALMINA-28 TABLET   2* Non-Preferred Generic $5.00$10.00None
FAMCICLOVIR 125MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FAMCICLOVIR 250MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FAMCICLOVIR 500MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FAMOTIDINE 20MG PIGGYBACK   2* Non-Preferred Generic $5.00$10.00None
FAMOTIDINE 20MG TABLET (500 CT)   1* Preferred Generic $1.00$0.00None
FAMOTIDINE 40MG TABLET   1* Preferred Generic $1.00$0.00None
FAMOTIDINE 50 MG/5MLFOR ORAL SUSPENSION   2* Non-Preferred Generic $5.00$10.00None
FAMOTIDINE INJECTION 10MG 25 X 2ML VIALSD   2* Non-Preferred Generic $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FANAPT 1 KIT in 1 DOSE PACK   4 Non-Preferred Brand 48%50%Q:8
/28Days
FANAPT 1 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:744
/31Days
FANAPT 10 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:93
/31Days
FANAPT 12 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:62
/31Days
FANAPT 2 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:1080
/90Days
FANAPT 4 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:186
/31Days
FANAPT 6 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:124
/31Days
FANAPT 8 MG 60 TABLET BOTTLE   4 Non-Preferred Brand 48%50%Q:93
/31Days
FARESTON 60 MG TABLET   3 Preferred Brand $40.00$100.00None
FARYDAK 10 MG CAPSULE   5 Specialty Tier 31%N/AP Q:12
/21Days
FARYDAK 15 MG CAPSULE   5 Specialty Tier 31%N/AP Q:6
/21Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FARYDAK 20 MG CAPSULE   5 Specialty Tier 31%N/AP Q:6
/21Days
FASLODEX 50MG/ML INJECTION   5 Specialty Tier 31%N/ANone
FazaClo 150mg/1 100 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE   4 Non-Preferred Brand 48%50%None
FAZACLO 200 MG TABLETS ORALLY DISINTEGRATING   4 Non-Preferred Brand 48%50%None
FELBAMATE 400 MG TABLET   4 Non-Preferred Brand 48%50%None
FELBAMATE 600 MG TABLET   4 Non-Preferred Brand 48%50%None
FELBAMATE 600 MG/5 ML SUSP   4 Non-Preferred Brand 48%50%None
FELBATOL 400MG TABLET   4 Non-Preferred Brand 48%50%None
FELBATOL 600MG TABLET   4 Non-Preferred Brand 48%50%None
FELBATOL 600MG/5ML SUSP   4 Non-Preferred Brand 48%50%None
FELODIPINE ER 10 MG TABLET   3 Preferred Brand $40.00$100.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FELODIPINE ER 2.5 MG TABLET   3 Preferred Brand $40.00$100.00None
FELODIPINE ER 5 MG TABLET   3 Preferred Brand $40.00$100.00None
FENOFIBRATE 130 MG CAPSULE   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 134MG CAPSULE   2* Non-Preferred Generic $5.00$10.00None
fenofibrate 145 mg tablet   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 160mg/1 90 TABLET BOTTLE   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 200MG CAPSULE   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 43 MG CAPSULE   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 48 MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FENOFIBRATE 50 MG ORAL CAPSULE [LIPOFEN]   4 Non-Preferred Brand 48%50%None
FENOFIBRATE 54mg/1 90 TABLET BOTTLE   2* Non-Preferred Generic $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENOFIBRATE 67MG CAPSULE   2* Non-Preferred Generic $5.00$10.00None
Fenofibric acid dr 135 mg capsule [TRILIPIX]   2* Non-Preferred Generic $5.00$10.00None
Fenofibric acid dr 45 mg capsule [TRILIPIX]   2* Non-Preferred Generic $5.00$10.00None
FENOPROFEN 600MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS   2* Non-Preferred Generic $5.00$10.00Q:10
/31Days
FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS   2* Non-Preferred Generic $5.00$10.00Q:10
/30Days
FENTANYL 75 MCG/HR PATCH   2* Non-Preferred Generic $5.00$10.00Q:10
/30Days
FENTANYL CITRATE 1600ug/1 30 BLISTER PACK per CARTON / 1 LOZENGE per BLISTER PACK   3 Preferred Brand $40.00$100.00P Q:30
/31Days
FENTANYL CITRATE 200ug/1 30 BLISTER PACK per CARTON / 1 LOZENGE per BLISTER PACK   3 Preferred Brand $40.00$100.00P Q:124
/31Days
FENTANYL CITRATE LOZENGES   3 Preferred Brand $40.00$100.00P Q:40
/31Days
FENTANYL CITRATE LOZENGES   3 Preferred Brand $40.00$100.00P Q:120
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENTANYL CITRATE LOZENGES   3 Preferred Brand $40.00$100.00P Q:80
/31Days
FENTANYL CITRATE LOZENGES   3 Preferred Brand $40.00$100.00P Q:60
/31Days
FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN   2* Non-Preferred Generic $5.00$10.00Q:10
/30Days
FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN   2* Non-Preferred Generic $5.00$10.00Q:10
/30Days
FERRIPROX 500 MG TABLET   5 Specialty Tier 31%N/ANone
FETZIMA 20-40 MG TITRATION PAK   4 Non-Preferred Brand 48%50%Q:28
/28Days
FETZIMA ER 120 MG CAPSULE   4 Non-Preferred Brand 48%50%Q:31
/31Days
FETZIMA ER 20 MG CAPSULE   4 Non-Preferred Brand 48%50%Q:186
/31Days
FETZIMA ER 40 MG CAPSULE   4 Non-Preferred Brand 48%50%Q:93
/31Days
FETZIMA ER 80 MG CAPSULE   4 Non-Preferred Brand 48%50%Q:47
/31Days
FINACEA 15% GEL   3 Preferred Brand $40.00$100.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FINASTERIDE 5MG TABLET   2* Non-Preferred Generic $5.00$10.00None
Firazyr 30.0mg/3mL 1 SYRINGE, GLASS per CARTON / 3 mL in 1 SYRINGE, GLASS   5 Specialty Tier 31%N/AP
FIRMAGON 2 X 120 MG KIT   3 Preferred Brand $40.00$100.00None
FIRMAGON 80 MG KIT   3 Preferred Brand $40.00$100.00None
FLAVOXATE HCL 100MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FLECAINIDE ACETATE 100 MG TAB #60 EA   2* Non-Preferred Generic $5.00$10.00None
FLECAINIDE ACETATE 150 MG TAB 360 EA   2* Non-Preferred Generic $5.00$10.00None
FLECAINIDE ACETATE 50 MG TAB   2* Non-Preferred Generic $5.00$10.00None
FLECTOR PATCH   4 Non-Preferred Brand 48%50%P Q:60
/30Days
FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER   3 Preferred Brand $40.00$100.00Q:120
/31Days
FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER   3 Preferred Brand $40.00$100.00Q:300
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLOVENT DISKUS POWDER 50MCG 60 CTR   3 Preferred Brand $40.00$100.00Q:120
/31Days
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $40.00$100.00Q:24
/31Days
FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $40.00$100.00Q:36
/31Days
FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $40.00$100.00Q:21
/31Days
FLUCONAZOLE 100 MG TABLET   1* Preferred Generic $1.00$0.00None
FLUCONAZOLE 10MG/ML ORAL SUSPENSION   1* Preferred Generic $1.00$0.00None
FLUCONAZOLE 150MG TABLETS   1* Preferred Generic $1.00$0.00None
Fluconazole 200mg/1 30 TABLET BOTTLE   1* Preferred Generic $1.00$0.00None
FLUCONAZOLE 40MG/ML ORAL SUSPENSION   1* Preferred Generic $1.00$0.00None
Fluconazole 50mg/1 30 TABLET BOTTLE   1* Preferred Generic $1.00$0.00None
FLUCONAZOLE INJECTION 200MG 6 X 200/250ML CTR   2* Non-Preferred Generic $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Flucytosine 250mg/1   3 Preferred Brand $40.00$100.00None
Flucytosine 500mg/1   3 Preferred Brand $40.00$100.00None
FLUDARABINE 50MG VIAL   3 Preferred Brand $40.00$100.00None
FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT)   2* Non-Preferred Generic $5.00$10.00None
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL   2* Non-Preferred Generic $5.00$10.00Q:50
/31Days
FLUOCINOLONE 0.01% BODY OIL   1* Preferred Generic $1.00$0.00None
FLUOCINOLONE 0.01% CREAM   3 Preferred Brand $40.00$100.00None
FLUOCINOLONE 0.01% SOLUTION   4 Non-Preferred Brand 48%50%None
FLUOCINOLONE 0.025% CREAM   3 Preferred Brand $40.00$100.00None
FLUOCINOLONE 0.025% OINTMENT   3 Preferred Brand $40.00$100.00None
FLUOCINOLONE OIL 0.01% EAR DRP   3 Preferred Brand $40.00$100.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUOCINONIDE 0.05% SOLUTION   2* Non-Preferred Generic $5.00$10.00None
fluocinonide 0.1% cream   2* Non-Preferred Generic $5.00$10.00None
Fluocinonide 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2* Non-Preferred Generic $5.00$10.00None
Fluocinonide 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE   2* Non-Preferred Generic $5.00$10.00None
Fluocinonide 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE   2* Non-Preferred Generic $5.00$10.00None
Fluorometholone 0.1% drops   2* Non-Preferred Generic $5.00$10.00None
FLUOROURACIL 2% TOPICAL SOLN   2* Non-Preferred Generic $5.00$10.00None
FLUOROURACIL 5% TOP SOLUTION   2* Non-Preferred Generic $5.00$10.00None
fluorouracil 500 mg/10 ml vial   2* Non-Preferred Generic $5.00$10.00None
FLUOROURACIL CREA 5%   2* Non-Preferred Generic $5.00$10.00None
Fluoxetine 10mg/1 30 FILM COATED TABLETS in BOTTLE   1* Preferred Generic $1.00$0.00Q:248
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC   1* Preferred Generic $1.00$0.00None
FLUOXETINE 40MG CAPSULE (30 CT)   1* Preferred Generic $1.00$0.00Q:62
/31Days
FLUOXETINE CAPSULES 10MG (100 CT)   1* Preferred Generic $1.00$0.00Q:248
/31Days
FLUOXETINE HCL 20 MG TABLET   1* Preferred Generic $1.00$0.00None
Fluoxetine Hydrochloride 20mg/1 100 CAPSULE BOTTLE   1* Preferred Generic $1.00$0.00None
FLUPHENAZINE 10MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE 1MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE 2.5MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE 2.5MG/ML VIAL   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE 5MG TABLET   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE 5MG/ML CONC   2* Non-Preferred Generic $5.00$10.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Fluphenazine Decanoate 25mg/mL   2* Non-Preferred Generic $5.00$10.00None
FLUPHENAZINE HCL 2.5MG/5ML ELIXIR   2* Non-Preferred Generic $5.00$10.00None
FLURBIPROFEN 0.03% EYE DROP   2* Non-Preferred Generic $5.00$10.00None
Flurbiprofen 100mg/1 100 BOTTLE in 1 BOTTLE / 100 FILM COATED TABLETS in BOTTLE   2* Non-Preferred Generic $5.00$10.00None
FLURBIPROFEN 50MG TABLET   2* Non-Preferred Generic $5.00$10.00None
Flutamide 125mg/1 500 CAPSULE BOTTLE   2* Non-Preferred Generic $5.00$10.00None
FLUTICASONE PROP 0.05% LOTION   2* Non-Preferred Generic $5.00$10.00None
Fluticasone Propionate 0.05mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2* Non-Preferred Generic $5.00$10.00None
Fluticasone Propionate 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2* Non-Preferred Generic $5.00$10.00None
FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION   2* Non-Preferred Generic $5.00$10.00Q:32
/31Days
FLUVASTATIN SODIUM 20 MG CAPSULE [Lescol]   2* Non-Preferred Generic $5.00$10.00Q:31
/31Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUVASTATIN SODIUM 40 MG CAPSULE [Lescol]   2* Non-Preferred Generic $5.00$10.00Q:62
/31Days
fluvoxamine er 100 mg capsule   2* Non-Preferred Generic $5.00$10.00Q:93
/31Days
fluvoxamine er 150 mg capsule   2* Non-Preferred Generic $5.00$10.00Q:62
/31Days
FLUVOXAMINE MALEATE 100MG TABLET   2* Non-Preferred Generic $5.00$10.00Q:93
/31Days
Fluvoxamine Maleate 25mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 100 FILM COATED TABLETS in   2* Non-Preferred Generic $5.00$10.00Q:1080
/90Days
Fluvoxamine maleate 50mg/1 100 FILM COATED TABLETS in BOTTLE   2* Non-Preferred Generic $5.00$10.00Q:186
/31Days
FML FORTE 0.25% EYE DROPS   4 Non-Preferred Brand 48%50%None
FML S.O.P. 0.1% OINTMENT   4 Non-Preferred Brand 48%50%None
FOLOTYN 20mg/mL 1 VIAL, SINGLE-USE per CARTON / 2 mL in 1 VIAL, SINGLE-USE   5 Specialty Tier 31%N/ANone
Fondaparinux Sodium 10mg/0.8mL 2 SYRINGES per CARTON / 0.8 mL in 1 SYRINGE [Arixtra]   4 Non-Preferred Brand 48%50%None
Fondaparinux Sodium 2.5mg/0.5mL 2 SYRINGES per CARTON / 0.5 mL in 1 SYRINGE [Arixtra]   4 Non-Preferred Brand 48%50%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Fondaparinux Sodium 5mg/4mL 2 SYRINGES per CARTON / 0.4 mL in 1 SYRINGE [Arixtra]   4 Non-Preferred Brand 48%50%None
Fondaparinux Sodium 7.5mg/0.6mL 2 SYRINGES per CARTON / 0.6 mL in 1 SYRINGE [Arixtra]   4 Non-Preferred Brand 48%50%None
FORADIL AEROLIZER 12 MCG CAP   3 Preferred Brand $40.00$100.00None
FORFIVO XL 450 MG TABLET   4 Non-Preferred Brand 48%50%Q:31
/31Days
FORTAZ 1 GM TWISTVIAL   3 Preferred Brand $40.00$100.00None
FORTAZ 2 GM TWISTVIAL   3 Preferred Brand $40.00$100.00None
FORTAZ 2 GM VIAL   4 Non-Preferred Brand 48%50%None
FORTAZ 6 GM VIAL   3 Preferred Brand $40.00$100.00None
Forteo 250ug/mL 1 SYRINGE per CARTON / 2.4 mL in 1 SYRINGE   4 Non-Preferred Brand 48%50%P Q:2
/28Days
FORTICAL 200 U/DOSE AEROSOL SPRAY W/PUMP   3 Preferred Brand $40.00$100.00None
FOSCARNET 24MG/ML INFUS BTTL   2* Non-Preferred Generic $5.00$10.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FOSINOPRIL SODIUM 10MG TABLET (90 CT)   2* Non-Preferred Generic $5.00$10.00None
FOSINOPRIL SODIUM 20MG TABLET   2* Non-Preferred Generic $5.00$10.00None
Fosinopril Sodium 40mg/1 90 TABLET BOTTLE   2* Non-Preferred Generic $5.00$10.00None
FOSINOPRIL-HCTZ 10-12.5 MG TAB   2* Non-Preferred Generic $5.00$10.00None
FOSINOPRIL-HCTZ 20-12.5 MG TAB   2* Non-Preferred Generic $5.00$10.00None
Fosphenytoin Sodium 50mg/mL 2 mL in 1 VIAL   2* Non-Preferred Generic $5.00$10.00None
FRAGMIN 2,500 UNITS SYRINGE   4 Non-Preferred Brand 48%50%None
FRAGMIN 5,000 UNITS SYRINGE   4 Non-Preferred Brand 48%50%None
FRAGMIN 95,000 UNITS/3.8 ML VL   4 Non-Preferred Brand 48%50%None
FREAMINE HBC INJECTION   3 Preferred Brand $40.00$100.00P
Furosemide 10mg/mL 10 CARTON in 1 CONTAINER / 1 SYRINGE, PLASTIC in 1 CARTON / 4 mL in 1 SYRINGE, P   1* Preferred Generic $1.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FUROSEMIDE 10MG/ML SOLUTION   1* Preferred Generic $1.00$0.00None
Furosemide 20mg/1 100 TABLET BOTTLE   1* Preferred Generic $1.00$0.00None
Furosemide 40 mg/4 ml vial   1* Preferred Generic $1.00$0.00None
Furosemide 40mg/1 5000 TABLET BOTTLE, PLASTIC   1* Preferred Generic $1.00$0.00None
FUROSEMIDE 40MG/5ML TUBEX   1* Preferred Generic $1.00$0.00None
FUROSEMIDE 80MG TABLET (500 CT)   1* Preferred Generic $1.00$0.00None
FUSILEV I.V. 50 MG VIAL   4 Non-Preferred Brand 48%50%None
FUZEON 90 MG VIAL   5 Specialty Tier 31%N/ANone
FYCOMPA 10 MG TABLET   4 Non-Preferred Brand 48%50%None
FYCOMPA 12 MG TABLET   4 Non-Preferred Brand 48%50%None
FYCOMPA 2 MG TABLET   4 Non-Preferred Brand 48%50%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FYCOMPA 4 MG TABLET   4 Non-Preferred Brand 48%50%None
FYCOMPA 6 MG TABLET   4 Non-Preferred Brand 48%50%None
FYCOMPA 8 MG TABLET   4 Non-Preferred Brand 48%50%None

Chart Legend:

Below are a few notes to help you understand the above 2015 Medicare Part D Express Scripts Medicare - Choice (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $320 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2960) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2016 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2015 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.