Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Home
  • Contact
  • MAPD
  • PDP
  • 2020
  • FAQs
  • Articles
  • Search
  • Contact
  • 2020
  • FAQs
  • Articles
  • Latest Medicare News
  • Search


2015 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

Transamerica MedicareRx Choice (PDP) (S9579-064-0)
Tier 1 (195)
Tier 2 (1569)
Tier 3 (547)
Tier 4 (273)
Tier 5 (389)
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
Transamerica MedicareRx Choice (PDP) (S9579-064-0)
Benefit Details           
The Transamerica MedicareRx Choice (PDP) (S9579-064-0)
Formulary Drugs Starting with the Letter M

in CMS PDP Region 32 which includes: CA
Plan Monthly Premium: $40.30 Deductible: $0 Qualifies for LIS: No
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   3 Preferred Brand $45.00$115.00None
Magnesium sulfate 50% vial   2 Non-Preferred Generic $18.00$45.00None
MAGNESIUM SULFATE INJECTION 5 GM/10ML   2 Non-Preferred Generic $18.00$45.00None
Malathion 5mg/mL 1 BOTTLE per CARTON / 59 mL in 1 BOTTLE   3 Preferred Brand $45.00$115.00None
MAPROTILINE 25MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MAPROTILINE 50MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MAPROTILINE 75MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MARLISSA-28 TABLET   2 Non-Preferred Generic $18.00$45.00None
MARPLAN 10MG TABLET (100 CT)   4 Non-Preferred Brand $95.00$240.00None
MATULANE 50MG CAPSULE   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Matzim LA 180mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC   3 Preferred Brand $45.00$115.00None
Matzim LA 240mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC   3 Preferred Brand $45.00$115.00None
Matzim LA 300mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC   3 Preferred Brand $45.00$115.00None
Matzim LA 360mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC   3 Preferred Brand $45.00$115.00None
Matzim LA 420mg/1 90 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC   3 Preferred Brand $45.00$115.00None
MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT   2 Non-Preferred Generic $18.00$45.00None
MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT   2 Non-Preferred Generic $18.00$45.00None
Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00None
Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00None
Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00None
MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN   2 Non-Preferred Generic $18.00$45.00Q:1
/84Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MEFLOQUINE HCL 250MG TABLET 25 BOT   2 Non-Preferred Generic $18.00$45.00None
MEGESTROL 20MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MEGESTROL ACETATE 40MG TABLET (250 CT)   2 Non-Preferred Generic $18.00$45.00None
Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC   2 Non-Preferred Generic $18.00$45.00None
MEKINIST 0.5 MG TABLET   5 Specialty Tier 33%33%P Q:90
/30Days
MEKINIST 2 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
MELOXICAM 15 MG TABLET   1 Preferred Generic $0.00$0.00None
MELOXICAM 7.5 MG TABLET   1 Preferred Generic $0.00$0.00None
MELOXICAM 7.5MG/5ML SUSPENSION ORAL   2 Non-Preferred Generic $18.00$45.00None
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   3 Preferred Brand $45.00$115.00None
MENEST 0.3MG TABLET   4 Non-Preferred Brand $95.00$240.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MENEST 0.625MG TABLET   4 Non-Preferred Brand $95.00$240.00P
MENEST 1.25MG TABLET   4 Non-Preferred Brand $95.00$240.00P
MENEST 2.5MG TABLET   4 Non-Preferred Brand $95.00$240.00P
MENOMUNE-A/C/Y/W-135 VIAL   3 Preferred Brand $45.00$115.00None
MENVEO INJECTION KIT   3 Preferred Brand $45.00$115.00None
MERCAPTOPURINE 50MG TABLET   3 Preferred Brand $45.00$115.00None
MEROPENEM 500MG/VIAL FOR INJECTION   2 Non-Preferred Generic $18.00$45.00None
Mesna 100 mg/ml vial   2 Non-Preferred Generic $18.00$45.00None
MESNEX 400MG TABLET   5 Specialty Tier 33%33%None
MESTINON 180MG TIMESPAN   4 Non-Preferred Brand $95.00$240.00None
MESTINON 60MG/5ML SYRUP   4 Non-Preferred Brand $95.00$240.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METAPROTERENOL 10MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METAPROTERENOL 20MG TABLET   2 Non-Preferred Generic $18.00$45.00None
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC   2 Non-Preferred Generic $18.00$45.00None
Metaxalone 400 MG TABLET   2 Non-Preferred Generic $18.00$45.00P
METAXALONE 800 MG TABLET   2 Non-Preferred Generic $18.00$45.00P
METFORMIN HCL 1000MG TABLET (500 CT)   1 Preferred Generic $0.00$0.00Q:60
/30Days
METFORMIN HCL 500MG TABLET (1000 CT)   1 Preferred Generic $0.00$0.00Q:120
/30Days
METFORMIN HCL ER 1,000 MG TAB   2 Non-Preferred Generic $18.00$45.00Q:60
/30Days
METFORMIN HCL ER 500MG TABLET SR 24HR   2 Non-Preferred Generic $18.00$45.00Q:120
/30Days
Metformin Hydrochloride 750mg/1   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE   1 Preferred Generic $0.00$0.00Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHADONE HCL 5MG TABLET (100 CT)   2 Non-Preferred Generic $18.00$45.00Q:360
/30Days
METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:360
/30Days
Methadone Hydrochloride 10mg/5mL   2 Non-Preferred Generic $18.00$45.00Q:1800
/30Days
Methadone Hydrochloride 5mg/5mL   2 Non-Preferred Generic $18.00$45.00Q:1800
/30Days
METHADONE HYDROCHLORIDE INJECTION 10MG/ML   2 Non-Preferred Generic $18.00$45.00None
METHAZOLAMIDE 25MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METHAZOLAMIDE 50MG TABLET   2 Non-Preferred Generic $18.00$45.00None
Methenamine Hippurate 1g/1   3 Preferred Brand $45.00$115.00None
METHIMAZOLE 10 MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METHIMAZOLE 5MG TABLETS   2 Non-Preferred Generic $18.00$45.00None
Methocarbamol 500mg 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHOCARBAMOL 750MG TABLET (500 CT)   2 Non-Preferred Generic $18.00$45.00P
methotrexate 1 gm vial   2 Non-Preferred Generic $18.00$45.00P
METHOTREXATE 2.5MG TABLET   2 Non-Preferred Generic $18.00$45.00P S
Methotrexate 25 mg/ml vial   2 Non-Preferred Generic $18.00$45.00P
Methoxsalen 10 mg Capsule [8-MOP]   5 Specialty Tier 33%33%None
METHSCOPOLAMINE BROMIDE 2.5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METHSCOPOLAMINE BROMIDE 5 MG TAB   2 Non-Preferred Generic $18.00$45.00None
METHYCLOTHIAZIDE 5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METHYLPHENIDATE 10MG TABLET   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
METHYLPHENIDATE 20MG TABLET   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
METHYLPHENIDATE ER 18 MG TAB   2 Non-Preferred Generic $18.00$45.00Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHYLPHENIDATE ER 27 MG TAB   2 Non-Preferred Generic $18.00$45.00Q:30
/30Days
METHYLPHENIDATE ER 36 MG TAB   2 Non-Preferred Generic $18.00$45.00Q:60
/30Days
METHYLPHENIDATE ER 54 MG TAB   2 Non-Preferred Generic $18.00$45.00Q:30
/30Days
Methylphenidate Hydrochloride 10mg/5mL 500 mL in 1 BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:900
/30Days
METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
Methylphenidate Hydrochloride 5mg/5mL 500 mL in 1 BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:900
/30Days
METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 10mg/1 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 20mg/1 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:90
/30Days
methylprednisolone 125 mg vial   2 Non-Preferred Generic $18.00$45.00P
METHYLPREDNISOLONE 16MG TABLET   2 Non-Preferred Generic $18.00$45.00P
METHYLPREDNISOLONE 32MG TABLET   2 Non-Preferred Generic $18.00$45.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
methylprednisolone 40 mg vial   2 Non-Preferred Generic $18.00$45.00P
Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE   2 Non-Preferred Generic $18.00$45.00P
Methylprednisolone 4mg/1 100 TABLET BOTTLE   2 Non-Preferred Generic $18.00$45.00P
METHYLPREDNISOLONE 8 MG ORAL TABLET   2 Non-Preferred Generic $18.00$45.00P
Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS per CARTON / 1 mL in 1 VIAL, GLASS   2 Non-Preferred Generic $18.00$45.00P
METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM   2 Non-Preferred Generic $18.00$45.00P
METIPRANOLOL 0.3% EYE DROPS   2 Non-Preferred Generic $18.00$45.00None
Metoclopramide 10mg/1 500 TABLET BOTTLE   1 Preferred Generic $0.00$0.00None
METOCLOPRAMIDE 5 MG TABLET   1 Preferred Generic $0.00$0.00None
METOCLOPRAMIDE 5 MG/5 ML SOLN   2 Non-Preferred Generic $18.00$45.00None
Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL   2 Non-Preferred Generic $18.00$45.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METOLAZONE 10MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METOLAZONE 2.5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METOLAZONE 5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
METOPROLOL SUCC ER 100 MG TAB   2 Non-Preferred Generic $18.00$45.00None
METOPROLOL SUCC ER 50 MG TAB   2 Non-Preferred Generic $18.00$45.00None
METOPROLOL SUCCINATE ER 200 MG TAB   2 Non-Preferred Generic $18.00$45.00None
METOPROLOL SUCCINATE ER 25 MG TAB   2 Non-Preferred Generic $18.00$45.00None
Metoprolol Tartrate 1mg/mL 3 AMPULE in 1 CARTON / 5 mL in 1 AMPULE   2 Non-Preferred Generic $18.00$45.00None
METOPROLOL TARTRATE 25MG TABLET (100 CT)   1 Preferred Generic $0.00$0.00None
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT)   1 Preferred Generic $0.00$0.00None
METOPROLOL TARTRATE TABLET USP 100MG (1000 CT)   1 Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET   3 Preferred Brand $45.00$115.00None
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET   3 Preferred Brand $45.00$115.00None
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET   3 Preferred Brand $45.00$115.00None
METRONIDAZOLE 0.75% CREAM   3 Preferred Brand $45.00$115.00None
METRONIDAZOLE 0.75% LOTION   3 Preferred Brand $45.00$115.00None
metronidazole 375 mg capsule   2 Non-Preferred Generic $18.00$45.00None
Metronidazole 500mg/100mL 24 BAG per CARTON / 100 mL in 1 BAG   2 Non-Preferred Generic $18.00$45.00None
METRONIDAZOLE TABLETS USP 250MG 250 BOTPL   2 Non-Preferred Generic $18.00$45.00None
METRONIDAZOLE TABLETS USP 500MG 100 BOTPL   2 Non-Preferred Generic $18.00$45.00None
metronidazole topical 1% gel   2 Non-Preferred Generic $18.00$45.00None
METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE   3 Preferred Brand $45.00$115.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METRONIDAZOLE VAGINAL GEL   2 Non-Preferred Generic $18.00$45.00None
MEXILETINE 150MG CAPSULE   2 Non-Preferred Generic $18.00$45.00None
MEXILETINE 200MG CAPSULE   2 Non-Preferred Generic $18.00$45.00None
MEXILETINE 250MG CAPSULE   2 Non-Preferred Generic $18.00$45.00None
MIACALCIN 200IU/ML VIAL   3 Preferred Brand $45.00$115.00P
MICROGESTIN 21 1-20 TABLET   2 Non-Preferred Generic $18.00$45.00None
MICROGESTIN 21 1.5-30 TAB   2 Non-Preferred Generic $18.00$45.00None
MICROGESTIN FE 1-20 TABLET   2 Non-Preferred Generic $18.00$45.00None
MICROGESTIN FE 1.5-30 TAB   2 Non-Preferred Generic $18.00$45.00None
MIDODRINE HCL 10MG TABLET   3 Preferred Brand $45.00$115.00None
MIDODRINE HCL 2.5MG TABLET   3 Preferred Brand $45.00$115.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MIDODRINE HCL 5MG TABLET (100 CT)   3 Preferred Brand $45.00$115.00None
Mimvey 1; 0.5mg/1; mg/1 1 BLISTER PACK in 1 CARTON / 28 FILM COATED TABLETS in BLISTER PACK   2 Non-Preferred Generic $18.00$45.00P
Mimvey lo 0.5-0.1 mg tablet   2 Non-Preferred Generic $18.00$45.00P
MINOCYCLINE 50MG CAPSULE   2 Non-Preferred Generic $18.00$45.00None
MINOCYCLINE HCL 75MG CAPSULE   2 Non-Preferred Generic $18.00$45.00None
Minocycline Hydrochloride 100mg/1 50 CAPSULE in 1 BOTTLE, PLASTIC   2 Non-Preferred Generic $18.00$45.00None
MINOXIDIL 10MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MINOXIDIL 2.5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MIRCERA 100 MCG/0.3 ML SYRINGE   4 Non-Preferred Brand $95.00$240.00P Q:1
/28Days
MIRCERA 50 MCG/0.3 ML SYRINGE   4 Non-Preferred Brand $95.00$240.00P Q:1
/28Days
MIRCERA 75 MCG/0.3 ML SYRINGE   4 Non-Preferred Brand $95.00$240.00P Q:1
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MIRTAZAPINE 15MG TABLET RAPID DISSOLVE   2 Non-Preferred Generic $18.00$45.00None
Mirtazapine 15mg/1 1000 FILM COATED TABLETS in BOTTLE   2 Non-Preferred Generic $18.00$45.00None
MIRTAZAPINE 30MG TABLET RAPID DISSOLVE   2 Non-Preferred Generic $18.00$45.00None
Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE   2 Non-Preferred Generic $18.00$45.00None
Mirtazapine 7.5mg/1 30 FILM COATED TABLETS in BOTTLE   2 Non-Preferred Generic $18.00$45.00None
MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX   2 Non-Preferred Generic $18.00$45.00None
MIRTAZAPINE TABLET 30MG (30 CT)   2 Non-Preferred Generic $18.00$45.00None
misoprostol 100 mcg tablet   2 Non-Preferred Generic $18.00$45.00None
misoprostol 200 mcg tablet   2 Non-Preferred Generic $18.00$45.00None
MITOXANTRONE INJECTION 2MG 125ML VIAL   2 Non-Preferred Generic $18.00$45.00None
Moexipril hcl 15 mg tablet   2 Non-Preferred Generic $18.00$45.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Moexipril HCL 7.5mg/1 100 FILM COATED TABLETS in BOTTLE   2 Non-Preferred Generic $18.00$45.00None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET   2 Non-Preferred Generic $18.00$45.00None
MOMETASONE FUROATE 0.1% OINT   2 Non-Preferred Generic $18.00$45.00None
MOMETASONE FUROATE 0.1% SOLN   2 Non-Preferred Generic $18.00$45.00None
Mometasone Furoate 1mg/g   2 Non-Preferred Generic $18.00$45.00None
MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN   2 Non-Preferred Generic $18.00$45.00None
MONTELUKAST SOD 10 MG TABLET [Singulair]   2 Non-Preferred Generic $18.00$45.00None
montelukast sod 4 mg granules [Singulair]   2 Non-Preferred Generic $18.00$45.00None
montelukast sod 4 mg tab chew [Singulair]   2 Non-Preferred Generic $18.00$45.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
montelukast sod 5 mg tab chew [Singulair]   2 Non-Preferred Generic $18.00$45.00None
MORPHINE 10 MG/ML ISECURE SYR   2 Non-Preferred Generic $18.00$45.00None
MORPHINE 2 MG/ML ISECURE SYR   2 Non-Preferred Generic $18.00$45.00None
MORPHINE 4 MG/ML ISECURE SYR   2 Non-Preferred Generic $18.00$45.00None
MORPHINE 8 MG/ML ISECURE SYR   2 Non-Preferred Generic $18.00$45.00None
MORPHINE SULFATE 100MG TABLET SA   2 Non-Preferred Generic $18.00$45.00Q:120
/30Days
MORPHINE SULFATE 100mg/5mL 15 mL in 1 BOTTLE   2 Non-Preferred Generic $18.00$45.00Q:200
/30Days
MORPHINE SULFATE 10MG/5ML ORAL SOLUTION   2 Non-Preferred Generic $18.00$45.00Q:700
/30Days
MORPHINE SULFATE 15MG TABLET SA   2 Non-Preferred Generic $18.00$45.00Q:180
/30Days
MORPHINE SULFATE 15MG TABLETS   2 Non-Preferred Generic $18.00$45.00Q:180
/30Days
MORPHINE SULFATE 200MG TABLET SA   2 Non-Preferred Generic $18.00$45.00Q:180
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MORPHINE SULFATE 20MG/5ML ORAL SOLUTION   2 Non-Preferred Generic $18.00$45.00Q:300
/30Days
MORPHINE SULFATE 30MG TABLET SA   2 Non-Preferred Generic $18.00$45.00Q:120
/30Days
MORPHINE SULFATE 30MG TABLETS   2 Non-Preferred Generic $18.00$45.00Q:180
/30Days
MORPHINE SULFATE TABLET ER 60MG (100 CT)   2 Non-Preferred Generic $18.00$45.00Q:120
/30Days
MOVANTIK 12.5 MG TABLET   3 Preferred Brand $45.00$115.00Q:30
/30Days
MOVANTIK 25 MG TABLET   3 Preferred Brand $45.00$115.00Q:30
/30Days
MOVIPREP 7.5-2.691G POWDER IN PACKET   3 Preferred Brand $45.00$115.00None
MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE   3 Preferred Brand $45.00$115.00None
MOXIFLOXACIN HCL 400 MG TABLET [Avelox]   2 Non-Preferred Generic $18.00$45.00None
MOZOBIL 20 MG/ML VIAL   5 Specialty Tier 33%33%None
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE   3 Preferred Brand $45.00$115.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
mupirocin 2% cream   2 Non-Preferred Generic $18.00$45.00None
MUPIROCIN 2% OINTMENT   2 Non-Preferred Generic $18.00$45.00None
MYCOPHENOLATE 200 MG/ML SUSP   5 Specialty Tier 33%33%P
Mycophenolate Mofetil 250mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK   3 Preferred Brand $45.00$115.00P
MYCOPHENOLATE MOFETIL TABLETS 500MG 500 BOT   3 Preferred Brand $45.00$115.00P
Mycophenolic Acid DR 180 mg tb   2 Non-Preferred Generic $18.00$45.00P
Mycophenolic Acid DR 360 mg tb   2 Non-Preferred Generic $18.00$45.00P
MYOZYME 50MG VIAL   5 Specialty Tier 33%33%None

Chart Legend:

Below are a few notes to help you understand the above 2015 Medicare Part D Transamerica MedicareRx 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
  • 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 PDP-Compare.com and MA-Compare.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.
  • 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.