2016 Medicare Part D Plan Formulary Information |
Medica Prime Solution Basic w/Rx 2 (Cost) (H2450-001-0)
Benefit Details
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The Medica Prime Solution Basic w/Rx 2 (Cost) (H2450-001-0) Formulary Drugs Starting with the Letter S in Sioux County, ND: CMS MA Region 19 which includes: ND Plan Monthly Premium: $157.70 Deductible: $0 |
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 ND cover SAIZEN 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SAIZEN 8.8 MG CLICK.EASY CARTG ![Compare how all Medicare Part D PDP plans in ND cover SAIZEN 8.8 MG CLICK.EASY CARTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SAIZEN 8.8 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SAIZEN 8.8 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SANDOSTATIN LAR DEPOT 10 MG KT ![Compare how all Medicare Part D PDP plans in ND cover SANDOSTATIN LAR DEPOT 10 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SANDOSTATIN LAR DEPOT 20 MG KT ![Compare how all Medicare Part D PDP plans in ND cover SANDOSTATIN LAR DEPOT 20 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SANDOSTATIN LAR DEPOT 30 MG KT ![Compare how all Medicare Part D PDP plans in ND cover SANDOSTATIN LAR DEPOT 30 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SANTYL OINTMENT ![Compare how all Medicare Part D PDP plans in ND cover SANTYL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SAPHRIS 10 MG TAB SL BLK CHERY ![Compare how all Medicare Part D PDP plans in ND cover SAPHRIS 10 MG TAB SL BLK CHERY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SAPHRIS 2.5 MG TAB SL BLK CHRY ![Compare how all Medicare Part D PDP plans in ND cover SAPHRIS 2.5 MG TAB SL BLK CHRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SAPHRIS 5 MG TAB SL BLK CHERRY ![Compare how all Medicare Part D PDP plans in ND cover SAPHRIS 5 MG TAB SL BLK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVAYSA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SAVAYSA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SAVAYSA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SAVAYSA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SAVAYSA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SAVAYSA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in ND cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:60 /30Days |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in ND cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:60 /30Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in ND cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:60 /30Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in ND cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:60 /30Days |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in ND cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:60 /30Days |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in ND cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN ![Compare how all Medicare Part D PDP plans in ND cover SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN ![Compare how all Medicare Part D PDP plans in ND cover SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:30 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN ![Compare how all Medicare Part D PDP plans in ND cover SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN ![Compare how all Medicare Part D PDP plans in ND cover SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in ND cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in ND cover Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in ND cover Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SERTRALINE HCL 100MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in ND cover SERTRALINE HCL 100MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SERTRALINE HCL 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in ND cover SERTRALINE HCL 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SERTRALINE HYDROCHLORIDE 20MG/ML ORAL CONCENTRATE ![Compare how all Medicare Part D PDP plans in ND cover SERTRALINE HYDROCHLORIDE 20MG/ML ORAL CONCENTRATE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SETLAKIN 0.15 MG-0.03 MG TAB ![Compare how all Medicare Part D PDP plans in ND cover SETLAKIN 0.15 MG-0.03 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:91 /84Days |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in ND cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in ND cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SHAROBEL 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SHAROBEL 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Signifor .3 mg/mL ![Compare how all Medicare Part D PDP plans in ND cover Signifor .3 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
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 ND cover Signifor .6 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
Signifor .9 mg/mL ![Compare how all Medicare Part D PDP plans in ND cover Signifor .9 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
Sildenafil 10 mg/12.5 ml vial ![Compare how all Medicare Part D PDP plans in ND cover Sildenafil 10 mg/12.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:38 /1Days |
SILDENAFIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SILDENAFIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:90 /30Days |
SILENOR 3 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SILENOR 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:30 /30Days |
SILENOR 6 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SILENOR 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:30 /30Days |
SILVER SULFADIAZINE 1% CRM ![Compare how all Medicare Part D PDP plans in ND cover SILVER SULFADIAZINE 1% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SIMBRINZA 1%-0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in ND cover SIMBRINZA 1%-0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SIMPONI 100 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in ND cover SIMPONI 100 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SIMPONI 100 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in ND cover SIMPONI 100 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SIMPONI 50 MG/0.5 ML PEN INJEC ![Compare how all Medicare Part D PDP plans in ND cover SIMPONI 50 MG/0.5 ML PEN INJEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMPONI ARIA 50 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SIMPONI ARIA 50 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in ND cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SIMVASTATIN 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in ND cover SIMVASTATIN 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SIMVASTATIN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SIMVASTATIN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SIMVASTATIN 80MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in ND cover SIMVASTATIN 80MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in ND cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in ND cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in ND cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:188 /168Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in ND cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sodium Chloride 3g/100mL ![Compare how all Medicare Part D PDP plans in ND cover Sodium Chloride 3g/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | 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 ND 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 |
Generic |
$15.00 | $30.00 | None |
Sodium Chloride 9g/1000mL 4 BAG in 1 PACKAGE / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in ND 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 |
Generic |
$15.00 | $30.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in ND cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SODIUM LACTATE 5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SODIUM LACTATE 5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
sodium polystyrene sulf pwd ![Compare how all Medicare Part D PDP plans in ND cover sodium polystyrene sulf pwd.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SOLTAMOX 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in ND cover SOLTAMOX 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SOLU CORTEF 250MG/VIAL INJECTION ![Compare how all Medicare Part D PDP plans in ND cover SOLU CORTEF 250MG/VIAL INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SOLU CORTEF INJECTION 100 MG/VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOLU CORTEF INJECTION 100 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMATULINE 60 MG/0.2 ML SYRING ![Compare how all Medicare Part D PDP plans in ND cover SOMATULINE 60 MG/0.2 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:1 /28Days |
SOMATULINE DEPOT 120 MG/0.5 ML ![Compare how all Medicare Part D PDP plans in ND cover SOMATULINE DEPOT 120 MG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:1 /28Days |
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 ND 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) |
5 |
Specialty Tier |
33% | 33% | Q:1 /28Days |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SOMAVERT 25 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOMAVERT 25 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SOMAVERT 30 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SOMAVERT 30 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in ND cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in ND cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in ND cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in ND cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SOTALOL HCL TABLET 240MG ![Compare how all Medicare Part D PDP plans in ND cover SOTALOL HCL TABLET 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in ND cover Sotalol Hydrochloride 120mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
sotalol hydrochloride 160mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover sotalol hydrochloride 160mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in ND cover Sotalol Hydrochloride 80mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SOVALDI 400 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SOVALDI 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:28 /28Days |
SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK ![Compare how all Medicare Part D PDP plans in ND cover SPIRIVA 18MCG CP-HANDIHALER 90 (9 X 10) BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SPIRIVA RESPIMAT 1.25 MCG INH ![Compare how all Medicare Part D PDP plans in ND cover SPIRIVA RESPIMAT 1.25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SPIRONOLACTONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPIRONOLACTONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SPIRONOLACTONE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in ND cover SPIRONOLACTONE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPIRONOLACTONE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in ND cover SPIRONOLACTONE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT) ![Compare how all Medicare Part D PDP plans in ND cover SPIRONOLACTONE/HCTZ TABLET 25-25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in ND cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SPRITAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRITAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:60 /30Days |
SPRITAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRITAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:120 /30Days |
SPRITAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRITAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:120 /30Days |
SPRITAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRITAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:120 /30Days |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SRONYX 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in ND cover SRONYX 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SSD Cream 10g/1000g 85 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in ND cover SSD Cream 10g/1000g 85 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STAVUDINE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in ND cover STAVUDINE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STAVUDINE CAPSULES 15MG 60 BOT ![Compare how all Medicare Part D PDP plans in ND cover STAVUDINE CAPSULES 15MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STAVUDINE CAPSULES 20MG 60 BOT ![Compare how all Medicare Part D PDP plans in ND cover STAVUDINE CAPSULES 20MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in ND cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in ND cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in ND cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in ND cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in ND cover Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
STERILE WATER FOR IRRIGATION ![Compare how all Medicare Part D PDP plans in ND cover STERILE WATER FOR IRRIGATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in ND cover Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
STIOLTO RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover STIOLTO RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | Q:4 /28Days |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:84 /28Days |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
STRENSIQ 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover STRENSIQ 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
STRENSIQ 80 MG/0.8 ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover STRENSIQ 80 MG/0.8 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in ND cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in ND cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
STRIVERDI RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover STRIVERDI RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in ND cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in ND cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover Sulfacetamide Sodium 100mg/mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in ND cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS ![Compare how all Medicare Part D PDP plans in ND cover SULFACETAMIDE-PREDNISOLONE 10-0.25% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sulfadiazine 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover Sulfadiazine 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL ![Compare how all Medicare Part D PDP plans in ND cover Sulfamethoxazole and Trimethoprim 200; 40mg/5mL; mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Sulfamethoxazole and Trimethoprim 800; 160mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover Sulfamethoxazole and Trimethoprim 800; 160mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SULFAMETHOXAZOLE W/TMP VIAL 80MG-16ML 10 X 10ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULFAMETHOXAZOLE-TMP SS TABLET ![Compare how all Medicare Part D PDP plans in ND cover SULFAMETHOXAZOLE-TMP SS TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
SULFASALAZINE 500MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SULFASALAZINE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULFAZINE EC 500MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in ND cover SULFAZINE EC 500MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULINDAC 150MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in ND cover SULINDAC 150MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SULINDAC 200MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SULINDAC 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
SUMATRIPTAN 20 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN 20 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:12 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN 4 MG/0.5 ML CART ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN 4 MG/0.5 ML CART.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:4 /28Days |
SUMATRIPTAN 5 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN 5 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:12 /28Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:4 /28Days |
SUMATRIPTAN 6 MG/0.5 ML REFILL ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN 6 MG/0.5 ML REFILL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:4 /28Days |
Sumatriptan 6 mg/0.5 ml vial ![Compare how all Medicare Part D PDP plans in ND cover Sumatriptan 6 mg/0.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:4 /28Days |
Sumatriptan Succinate 25mg/1 9 BLISTER PACK per CARTON / 9 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in ND 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 |
Generic |
$15.00 | $30.00 | Q:18 /28Days |
Sumatriptan Succinate 50 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover Sumatriptan Succinate 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | 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 ND 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 |
Generic |
$15.00 | $30.00 | Q:4 /28Days |
SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD ![Compare how all Medicare Part D PDP plans in ND cover SUMATRIPTAN SUCCINATE TABLETS 100MG 9 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:18 /28Days |
SUPRAX 100 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in ND cover SUPRAX 100 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SUPRAX 200 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in ND cover SUPRAX 200 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in ND cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SURMONTIL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SURMONTIL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | P |
SURMONTIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SURMONTIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | P |
Surmontil 50mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover Surmontil 50mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | P |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SUTENT 25mg/1 28 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in ND cover SUTENT 25mg/1 28 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SUTENT 37.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SUTENT 37.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYLATRON 200 MCG KIT ![Compare how all Medicare Part D PDP plans in ND cover SYLATRON 200 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days |
SYLATRON 300 MCG KIT ![Compare how all Medicare Part D PDP plans in ND cover SYLATRON 300 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days |
SYLATRON 600 MCG KIT ![Compare how all Medicare Part D PDP plans in ND cover SYLATRON 600 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days |
SYLVANT 100 MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SYLVANT 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in ND cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | Q:11 /28Days |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in ND cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | Q:6 /28Days |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in ND cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in ND cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
SYNJARDY 12.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SYNJARDY 12.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | S |
SYNJARDY 12.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SYNJARDY 12.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNJARDY 5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SYNJARDY 5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | S |
SYNJARDY 5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in ND cover SYNJARDY 5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$43.00 | $86.00 | S |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in ND cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:28 /28Days |
SYPRINE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in ND cover SYPRINE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |