2015 Medicare Part D Plan Formulary Information |
Humana Preferred Rx Plan (PDP) (S5884-147-0)
Benefit Details
 |
The Humana Preferred Rx Plan (PDP) (S5884-147-0) Formulary Drugs Starting with the Letter M in CMS PDP Region 31 which includes: ID UT Plan Monthly Premium: $29.00 Deductible: $320 Qualifies for LIS: Yes |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Magnesium sulfate 50% vial  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MAGNESIUM SULFATE INJECTION 5 GM/10ML  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Malathion 5mg/mL 1 BOTTLE per CARTON / 59 mL in 1 BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MAPROTILINE 25MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MAPROTILINE 50MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MAPROTILINE 75MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MARLISSA-28 TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MARPLAN 10MG TABLET (100 CT)  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MATULANE 50MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT  |
3 |
Preferred Brand |
20% | 17% | None |
MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT  |
3 |
Preferred Brand |
20% | 17% | None |
MECLOFENAMATE 100MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MECLOFENAMATE 50MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:1 /90Days |
MEFLOQUINE HCL 250MG TABLET 25 BOT  |
3 |
Preferred Brand |
20% | 17% | None |
MEGESTROL 20MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | P |
MEGESTROL ACETATE 40MG TABLET (250 CT)  |
3 |
Preferred Brand |
20% | 17% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC  |
3 |
Preferred Brand |
20% | 17% | P |
MEKINIST 0.5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
MEKINIST 2 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
MELOXICAM 15 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $0.00 | Q:30 /30Days |
MELOXICAM 7.5 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $0.00 | Q:60 /30Days |
MELOXICAM 7.5MG/5ML SUSPENSION ORAL  |
3 |
Preferred Brand |
20% | 17% | Q:300 /30Days |
MELPHALAN 5 MG/ML INJECTABLE SOLUTION  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MENEST 0.3MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MENEST 0.625MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MENEST 1.25MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MENEST 2.5MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MENOMUNE-A/C/Y/W-135 VIAL  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MENTAX 1% CREAM 15G TUBE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MENVEO INJECTION KIT  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MEPRON 750MG/5ML ORAL SUSP  |
5 |
Specialty Tier |
25% | N/A | None |
MERCAPTOPURINE 50MG TABLET  |
3 |
Preferred Brand |
20% | 17% | None |
MEROPENEM 500MG/VIAL FOR INJECTION  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Mesalamine 1 KIT per CARTON  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Mesna 100 mg/ml vial  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MESNEX 100MG/ML INJECTION  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MESNEX 400MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METAPROTERENOL 10MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METAPROTERENOL 20MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METFORMIN HCL 1000MG TABLET (500 CT)  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METFORMIN HCL 500MG TABLET (1000 CT)  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METFORMIN HCL ER 500MG TABLET SR 24HR  |
1 |
Preferred Generic |
$1.00 | $0.00 | Q:120 /30Days |
Metformin Hydrochloride 750mg/1  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METHADONE HCL 5MG TABLET (100 CT)  |
4 |
Non-Preferred Brand |
35% | 35% | Q:480 /30Days |
METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:240 /30Days |
Methadone Hydrochloride 10mg/5mL  |
4 |
Non-Preferred Brand |
35% | 35% | Q:1800 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methadone Hydrochloride 5mg/5mL  |
4 |
Non-Preferred Brand |
35% | 35% | Q:3600 /30Days |
METHADONE HYDROCHLORIDE INJECTION 10MG/ML  |
4 |
Non-Preferred Brand |
35% | 35% | Q:360 /30Days |
METHAMPHETAMINE HYDROCHLORIDE TABLETS 5 MG  |
4 |
Non-Preferred Brand |
35% | 35% | Q:150 /30Days |
METHAZOLAMIDE 25MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METHAZOLAMIDE 50MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Methenamine Hippurate 1g/1  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METHIMAZOLE 10 MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METHIMAZOLE 5MG TABLETS  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METHITEST 10MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Methocarbamol 500mg 100 TABLET BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | P |
METHOCARBAMOL 750MG TABLET (500 CT)  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
methotrexate 1 gm vial  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METHOTREXATE 2.5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | P |
Methotrexate 25 mg/ml vial  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Methoxsalen 10 mg Capsule [8-MOP] ![Compare how all Medicare Part D PDP plans in ID cover Methoxsalen 10 mg Capsule [8-MOP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
METHYCLOTHIAZIDE 5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Methylergonovine Maleate 0.2mg/1 28 TABLET BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METHYLIN 10 MG CHEWABLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:180 /30Days |
METHYLIN 2.5 MG CHEWABLE TAB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:150 /30Days |
METHYLIN 5 MG CHEWABLE TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | Q:150 /30Days |
METHYLPHENIDATE 10 MG CHEW TB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:180 /30Days |
METHYLPHENIDATE 10MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE 2.5 MG CHEW TB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:150 /30Days |
METHYLPHENIDATE 20MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | Q:90 /30Days |
METHYLPHENIDATE 5 MG CHEW TB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:150 /30Days |
METHYLPHENIDATE ER 18 MG TAB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
METHYLPHENIDATE ER 20 MG CAP  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
METHYLPHENIDATE ER 27 MG TAB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
METHYLPHENIDATE ER 30 MG CAP  |
4 |
Non-Preferred Brand |
35% | 35% | Q:60 /30Days |
METHYLPHENIDATE ER 36 MG TAB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:60 /30Days |
METHYLPHENIDATE ER 40 MG CAP  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
METHYLPHENIDATE ER 54 MG TAB  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
Methylphenidate Hydrochloride 10mg/5mL 500 mL in 1 BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:900 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:90 /30Days |
Methylphenidate Hydrochloride 5mg/5mL 500 mL in 1 BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:1800 /30Days |
METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 10mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:90 /30Days |
METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 20mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:90 /30Days |
methylprednisolone 125 mg vial  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METHYLPREDNISOLONE 16MG TABLET  |
3 |
Preferred Brand |
20% | 17% | P |
METHYLPREDNISOLONE 32MG TABLET  |
3 |
Preferred Brand |
20% | 17% | P |
methylprednisolone 40 mg vial  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Methylprednisolone 4mg/1 100 TABLET BOTTLE  |
3 |
Preferred Brand |
20% | 17% | P |
METHYLPREDNISOLONE 8 MG ORAL TABLET  |
3 |
Preferred Brand |
20% | 17% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS per CARTON / 1 mL in 1 VIAL, GLASS  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM  |
3 |
Preferred Brand |
20% | 17% | P |
METIPRANOLOL 0.3% EYE DROPS  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOCLOPRAMIDE 5 MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOCLOPRAMIDE 5 MG/5 ML SOLN  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOLAZONE 10MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOLAZONE 2.5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOLAZONE 5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOPROLOL SUCC ER 100 MG TAB  |
3 |
Preferred Brand |
20% | 17% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL SUCC ER 50 MG TAB  |
3 |
Preferred Brand |
20% | 17% | Q:60 /30Days |
METOPROLOL SUCCINATE ER 200 MG TAB  |
3 |
Preferred Brand |
20% | 17% | Q:60 /30Days |
METOPROLOL SUCCINATE ER 25 MG TAB  |
3 |
Preferred Brand |
20% | 17% | Q:60 /30Days |
Metoprolol Tartrate 1mg/mL 3 AMPULE in 1 CARTON / 5 mL in 1 AMPULE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METOPROLOL TARTRATE 25MG TABLET (100 CT)  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT)  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METOPROLOL TARTRATE TABLET USP 100MG (1000 CT)  |
1 |
Preferred Generic |
$1.00 | $0.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET  |
3 |
Preferred Brand |
20% | 17% | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET  |
3 |
Preferred Brand |
20% | 17% | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET  |
3 |
Preferred Brand |
20% | 17% | None |
METRONIDAZOLE 0.75% CREAM  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METRONIDAZOLE 0.75% LOTION  |
4 |
Non-Preferred Brand |
35% | 35% | None |
metronidazole 375 mg capsule  |
3 |
Preferred Brand |
20% | 17% | None |
Metronidazole 500mg/100mL 24 BAG per CARTON / 100 mL in 1 BAG  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METRONIDAZOLE TABLETS USP 250MG 250 BOTPL  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
METRONIDAZOLE TABLETS USP 500MG 100 BOTPL  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
metronidazole topical 1% gel  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
METRONIDAZOLE VAGINAL GEL  |
3 |
Preferred Brand |
20% | 17% | None |
MEXILETINE 150MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MEXILETINE 200MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MEXILETINE 250MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MICONAZOLE 3 200MG SUPPOS.  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MICROGESTIN 21 1-20 TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MICROGESTIN 21 1.5-30 TAB  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MICROGESTIN FE 1-20 TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MICROGESTIN FE 1.5-30 TAB  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MIDODRINE HCL 10MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MIDODRINE HCL 2.5MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MIDODRINE HCL 5MG TABLET (100 CT)  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Migergot suppository  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Mimvey 1; 0.5mg/1; mg/1 1 BLISTER PACK in 1 CARTON / 28 FILM COATED TABLETS in BLISTER PACK  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MINOCYCLINE 50MG CAPSULE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MINOCYCLINE HCL 75MG CAPSULE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Minocycline Hydrochloride 100mg/1 50 CAPSULE in 1 BOTTLE, PLASTIC  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Minocycline Hydrochloride 100mg/1 60 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Minocycline Hydrochloride 75mg/1 100 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MINOCYCLINE HYDROCHLORIDE TABLETS 50MG  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MINOXIDIL 10MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MINOXIDIL 2.5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MIRTAZAPINE 15MG TABLET RAPID DISSOLVE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
Mirtazapine 15mg/1 1000 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
MIRTAZAPINE 30MG TABLET RAPID DISSOLVE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Mirtazapine 7.5mg/1 30 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX  |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
MIRTAZAPINE TABLET 30MG (30 CT)  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
misoprostol 100 mcg tablet  |
3 |
Preferred Brand |
20% | 17% | None |
misoprostol 200 mcg tablet  |
3 |
Preferred Brand |
20% | 17% | None |
MITOMYCIN 20 MG VIAL  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MITOXANTRONE INJECTION 2MG 125ML VIAL  |
3 |
Preferred Brand |
20% | 17% | None |
Modafinil 100 mg tablet [Provigil] ![Compare how all Medicare Part D PDP plans in ID cover Modafinil 100 mg tablet [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
35% | 35% | P Q:60 /30Days |
Modafinil 200 mg tablet [Provigil] ![Compare how all Medicare Part D PDP plans in ID cover Modafinil 200 mg tablet [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
35% | 35% | P Q:60 /30Days |
Moexipril hcl 15 mg tablet  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Moexipril HCL 7.5mg/1 100 FILM COATED TABLETS in BOTTLE  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MOMETASONE FUROATE 0.1% OINT  |
3 |
Preferred Brand |
20% | 17% | None |
MOMETASONE FUROATE 0.1% SOLN  |
3 |
Preferred Brand |
20% | 17% | None |
Mometasone Furoate 1mg/g  |
3 |
Preferred Brand |
20% | 17% | None |
MONTELUKAST SOD 10 MG TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in ID cover MONTELUKAST SOD 10 MG TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
montelukast sod 4 mg granules [Singulair] ![Compare how all Medicare Part D PDP plans in ID cover montelukast sod 4 mg granules [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
35% | 35% | Q:30 /30Days |
montelukast sod 4 mg tab chew [Singulair] ![Compare how all Medicare Part D PDP plans in ID cover montelukast sod 4 mg tab chew [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
montelukast sod 5 mg tab chew [Singulair] ![Compare how all Medicare Part D PDP plans in ID cover montelukast sod 5 mg tab chew [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
MORPHINE 10 MG/ML ISECURE SYR  |
3 |
Preferred Brand |
20% | 17% | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE 2 MG/ML ISECURE SYR  |
3 |
Preferred Brand |
20% | 17% | Q:1800 /30Days |
MORPHINE 4 MG/ML ISECURE SYR  |
3 |
Preferred Brand |
20% | 17% | Q:900 /30Days |
MORPHINE 8 MG/ML ISECURE SYR  |
3 |
Preferred Brand |
20% | 17% | Q:450 /30Days |
MORPHINE SULFATE 100MG TABLET SA  |
3 |
Preferred Brand |
20% | 17% | Q:180 /30Days |
MORPHINE SULFATE 100mg/5mL 15 mL in 1 BOTTLE  |
3 |
Preferred Brand |
20% | 17% | Q:600 /30Days |
MORPHINE SULFATE 10MG/5ML ORAL SOLUTION  |
3 |
Preferred Brand |
20% | 17% | Q:2700 /30Days |
MORPHINE SULFATE 15MG TABLET SA  |
3 |
Preferred Brand |
20% | 17% | Q:120 /30Days |
MORPHINE SULFATE 15MG TABLETS  |
3 |
Preferred Brand |
20% | 17% | Q:180 /30Days |
MORPHINE SULFATE 200MG TABLET SA  |
3 |
Preferred Brand |
20% | 17% | Q:90 /30Days |
MORPHINE SULFATE 20MG/5ML ORAL SOLUTION  |
3 |
Preferred Brand |
20% | 17% | Q:1350 /30Days |
MORPHINE SULFATE 30MG TABLET SA  |
3 |
Preferred Brand |
20% | 17% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULFATE 30MG TABLETS  |
3 |
Preferred Brand |
20% | 17% | Q:180 /30Days |
MORPHINE SULFATE TABLET ER 60MG (100 CT)  |
3 |
Preferred Brand |
20% | 17% | Q:120 /30Days |
MOVIPREP 7.5-2.691G POWDER IN PACKET  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MOZOBIL 20 MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /30Days |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE  |
4 |
Non-Preferred Brand |
35% | 35% | Q:60 /30Days |
mupirocin 2% cream  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MUPIROCIN 2% OINTMENT  |
2 |
Non-Preferred Generic |
$2.00 | $0.00 | None |
MUSTARGEN 10 MG VIAL  |
4 |
Non-Preferred Brand |
35% | 35% | None |
MYALEPT 11.3 MG (5 MG/ML) VIAL  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
MYCOBUTIN 150MG CAPSULE  |
4 |
Non-Preferred Brand |
35% | 35% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MYCOPHENOLATE 200 MG/ML SUSP  |
4 |
Non-Preferred Brand |
35% | 35% | P |
Mycophenolate Mofetil 250mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK  |
3 |
Preferred Brand |
20% | 17% | P |
MYCOPHENOLATE MOFETIL TABLETS 500MG 500 BOT  |
3 |
Preferred Brand |
20% | 17% | P |
Mycophenolic Acid DR 180 mg tb  |
3 |
Preferred Brand |
20% | 17% | P |
Mycophenolic Acid DR 360 mg tb  |
3 |
Preferred Brand |
20% | 17% | P |
MYFORTIC 180MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MYFORTIC 360MG TABLET  |
4 |
Non-Preferred Brand |
35% | 35% | P |
MYOZYME 50MG VIAL  |
5 |
Specialty Tier |
25% | N/A | P |