2016 Medicare Part D Plan Formulary Information |
Personal Choice 65 Rx (PPO) (H3909-001-0)
Benefit Details
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The Personal Choice 65 Rx (PPO) (H3909-001-0) Formulary Drugs Starting with the Letter A in Bucks County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $251.00 Deductible: $320 |
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
A-HYDROCORT 100MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover A-HYDROCORT 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ABACAVIR 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ABACAVIR 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir] ![Compare how all Medicare Part D PDP plans in PA cover Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ABELCENT INJECTION SUSPENSION 5MG/ML ![Compare how all Medicare Part D PDP plans in PA cover ABELCENT INJECTION SUSPENSION 5MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ABILIFY MAINTENA ER 300 MG SYR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 300 MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ABILIFY MAINTENA ER 300 MG VL ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 300 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ABILIFY MAINTENA ER 400 MG SYR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 400 MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ABRAXANE 100MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ABRAXANE 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ABSORICA 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ABSORICA 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABSORICA 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ABSORICA 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ABSORICA 35 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 35 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ABSORICA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ABSORICA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ABSTRAL 100 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 100 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
ABSTRAL 200 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 200 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
ABSTRAL 300 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 300 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
ABSTRAL 400 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 400 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
ABSTRAL 600 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 600 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
ABSTRAL 800 MCG TAB SUBLINGUAL ![Compare how all Medicare Part D PDP plans in PA cover ABSTRAL 800 MCG TAB SUBLINGUAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P Q:120 /30Days |
Acamprosate Calcium DR 333 MG tablets [Campral] ![Compare how all Medicare Part D PDP plans in PA cover Acamprosate Calcium DR 333 MG tablets [Campral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACARBOSE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACARBOSE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ACARBOSE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACARBOSE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
Acarbose 50mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Acarbose 50mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ACEBUTOLOL 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ACEBUTOLOL 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACEBUTOLOL 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ACEBUTOLOL 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE ![Compare how all Medicare Part D PDP plans in PA cover ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:2700 /30Days |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:180 /30Days |
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:180 /30Days |
ACETAMINOPHEN-COD #4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN-COD #4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:180 /30Days |
ACETASOL HC SOLUTION 10ML 10 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover ACETASOL HC SOLUTION 10ML 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETAZOLAMIDE 125MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACETAZOLAMIDE 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Acetazolamide 500mg/5mL 1 VIAL in 1 CARTON / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Acetazolamide 500mg/5mL 1 VIAL in 1 CARTON / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACETAZOLAMIDE ER CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE ER CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACETIC ACID 2% EAR SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover ACETIC ACID 2% EAR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACETYLCYSTEINE 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACETYLCYSTEINE 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ACETYLCYSTEINE 20% VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACETYLCYSTEINE 20% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ACITRETIN 10 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 10 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ACITRETIN 17.5 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 17.5 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ACITRETIN 25 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 25 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ACTEMRA 162 MG/0.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA 162 MG/0.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACTEMRA 400 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA 400 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ACTEMRA 80 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA 80 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ACTEMRA INJECTION 200MG/10ML ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA INJECTION 200MG/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ACTHIB VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in PA cover ACTHIB VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
ACTIMMUNE 100 MCG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACTIMMUNE 100 MCG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Acyclovir 200mg 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Acyclovir 200mg 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Acyclovir 200mg/5mL 473 mL BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Acyclovir 200mg/5mL 473 mL BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Acyclovir 400mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Acyclovir 400mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Acyclovir 5% Ointment ![Compare how all Medicare Part D PDP plans in PA cover Acyclovir 5% Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ACYCLOVIR 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Acyclovir sodium 500 mg vial ![Compare how all Medicare Part D PDP plans in PA cover Acyclovir sodium 500 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACZONE 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover ACZONE 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in PA cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
ADAGEN 250U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ADAGEN 250U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA] ![Compare how all Medicare Part D PDP plans in PA cover ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:2 /28Days |
ADAPALENE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover ADAPALENE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ADAPALENE 0.1% GEL ![Compare how all Medicare Part D PDP plans in PA cover ADAPALENE 0.1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Adapalene 0.3% gel ![Compare how all Medicare Part D PDP plans in PA cover Adapalene 0.3% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ADCIRCA TABLETS 20MG 60 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover ADCIRCA TABLETS 20MG 60 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera] ![Compare how all Medicare Part D PDP plans in PA cover ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | Q:30 /30Days |
ADEMPAS 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ADEMPAS 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADEMPAS 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ADEMPAS 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ADEMPAS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Adrenalin 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Adrenalin 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ADRUCIL 50mg/mL 10 VIAL in 1 TRAY / 10 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover ADRUCIL 50mg/mL 10 VIAL in 1 TRAY / 10 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ADVAIR DISKUS MIS 100/50 ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR DISKUS MIS 100/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:60 /30Days |
ADVAIR DISKUS MIS 250/50 ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR DISKUS MIS 250/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:60 /30Days |
ADVAIR DISKUS MIS 500/50 ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR DISKUS MIS 500/50.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:60 /30Days |
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:12 /30Days |
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:12 /30Days |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:12 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFEDITAB CR 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover AFEDITAB CR 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AFEDITAB CR 60MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover AFEDITAB CR 60MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR DISPERZ 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR DISPERZ 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR DISPERZ 3 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR DISPERZ 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR DISPERZ 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR DISPERZ 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR TABLETS 2.5 MG ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR TABLETS 2.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AFINITOR TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in PA cover AFINITOR TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AGGRENOX 25-200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AGGRENOX 25-200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AKYNZEO 300-0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AKYNZEO 300-0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALA-CORT 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover ALA-CORT 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALBENZA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALBENZA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ALBUTEROL SULFATE 4MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 4MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALBUTEROL SULFATE 8MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 8MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ALBUTEROL SULFATE SOLUTION FOR INHALATION ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE SOLUTION FOR INHALATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALBUTEROL SULFATE TABLET 2MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE TABLET 2MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALBUTEROL TABLET 4MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL TABLET 4MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALCLOMETASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover ALCLOMETASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Alclometasone Dipropionate 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Alclometasone Dipropionate 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALDURAZYME 2.9MG/5ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ALDURAZYME 2.9MG/5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ALECENSA 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ALECENSA 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ALENDRONATE SODIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:30 /30Days |
ALENDRONATE SODIUM 35 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:4 /28Days |
ALENDRONATE SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:30 /30Days |
ALENDRONATE SODIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:30 /30Days |
Alendronate Sodium 70 mg/75 ml ![Compare how all Medicare Part D PDP plans in PA cover Alendronate Sodium 70 mg/75 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:300 /28Days |
Alendronate Sodium 70mg/1 4 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Alendronate Sodium 70mg/1 4 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:4 /28Days |
ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALIMTA 500MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ALIMTA 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ALINIA 100MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover ALINIA 100MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ALINIA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALINIA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ALLOPURINOL 100 MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover ALLOPURINOL 100 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALMOTRIPTAN MALATE 12.5 MG TAB [Axert] ![Compare how all Medicare Part D PDP plans in PA cover ALMOTRIPTAN MALATE 12.5 MG TAB [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:8 /30Days |
ALMOTRIPTAN MALATE 6.25 MG TAB [Axert] ![Compare how all Medicare Part D PDP plans in PA cover ALMOTRIPTAN MALATE 6.25 MG TAB [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:8 /30Days |
ALOCRIL 2% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover ALOCRIL 2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ALOGLIPTIN 12.5 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN 12.5 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN 25 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN 25 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN 6.25 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN 6.25 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALOGLIPTIN-METFORMIN 12.5-1000 [Kazano] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-METFORMIN 12.5-1000 [Kazano].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-METFORMIN 12.5-500 [Kazano] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-METFORMIN 12.5-500 [Kazano].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 12.5-15 MG [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 12.5-15 MG [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 12.5-30 MG [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 12.5-30 MG [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 12.5-45 MG [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 12.5-45 MG [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 25-15 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 25-15 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 25-30 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 25-30 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOGLIPTIN-PIOGLIT 25-45 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in PA cover ALOGLIPTIN-PIOGLIT 25-45 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ALOSETRON HCL 0.5 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in PA cover ALOSETRON HCL 0.5 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALOSETRON HCL 1 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in PA cover ALOSETRON HCL 1 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ALOXI 0.25 MG/5 ML ![Compare how all Medicare Part D PDP plans in PA cover ALOXI 0.25 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALPHAGAN P 0.1% DROPS ![Compare how all Medicare Part D PDP plans in PA cover ALPHAGAN P 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ALPRAZOLAM 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:120 /30Days |
ALPRAZOLAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:120 /30Days |
ALPRAZOLAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:60 /30Days |
Alprazolam 1mg/mL 1 BOTTLE in 1 CONTAINER / 30 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Alprazolam 1mg/mL 1 BOTTLE in 1 CONTAINER / 30 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:300 /30Days |
ALPRAZOLAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | Q:150 /30Days |
ALTABAX 10mg/g 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover ALTABAX 10mg/g 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMANTADINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMANTADINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMANTADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMANTADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Amantadine Hydrochloride 50mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Amantadine Hydrochloride 50mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMBISOME 50MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMBISOME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMCINONIDE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover AMCINONIDE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMCINONIDE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover AMCINONIDE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMCINONIDE 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover AMCINONIDE 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Amethia 2 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Amethia 2 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK per CARTON / 28 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK per CARTON / 28 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMIFOSTINE 50mg/mL 3 VIAL, SINGLE-USE per CARTON / 10 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in PA cover AMIFOSTINE 50mg/mL 3 VIAL, SINGLE-USE per CARTON / 10 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
AMIKACIN SULFATE 500 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMIKACIN SULFATE 500 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMILORIDE HCL W/HCTZ 5MG-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Amino Acids 15% Solution ![Compare how all Medicare Part D PDP plans in PA cover Amino Acids 15% Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Aminophylline 25mg/mL 5 TRAY per CARTON / 5 AMPULE in 1 TRAY / 10 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in PA cover Aminophylline 25mg/mL 5 TRAY per CARTON / 5 AMPULE in 1 TRAY / 10 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN 7%-ELECTROLYTE SOL ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN 7%-ELECTROLYTE SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN HBC INJECTION SULFITE FREE 7% ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN HBC INJECTION SULFITE FREE 7%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN II 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN II 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN II 15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN II 15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN II 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN II 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN II 8.5% ELECTROLYT ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN II 8.5% ELECTROLYT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMINOSYN II 8.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN II 8.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN M 3.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN M 3.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN PF INJECTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN PF INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5% ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMINOSYN-PF 7% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN-PF 7% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMINOSYN-RF 5.2% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMINOSYN-RF 5.2% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AMIODARONE HCL 200MG 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 200MG 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMIODARONE HCL 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMIODARONE HCL 50 MG INJECTION ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 50 MG INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMITIZA 8MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMITIZA 8MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
AMITIZA CAPSULES 24MCG 60 CAP BOT ![Compare how all Medicare Part D PDP plans in PA cover AMITIZA CAPSULES 24MCG 60 CAP BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
AMITRIP/PERPHEN 10-2 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 10-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIP/PERPHEN 10-4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 10-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIP/PERPHEN 25-2 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 25-2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIP/PERPHEN 25-4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 25-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIP/PERPHEN 50-4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 50-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIPTYLINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIPTYLINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIPTYLINE HCL 150 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 25MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 75MG TABLET USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AMLOD-VALSA-HCTZ 10-160-12.5 MG [EXFORGE HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-160-12.5 MG [EXFORGE HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMLOD-VALSA-HCTZ 10-160-25 MG [EXFORGE HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-160-25 MG [EXFORGE HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMLOD-VALSA-HCTZ 10-320-25 MG [EXFORGE HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-320-25 MG [EXFORGE HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMLOD-VALSA-HCTZ 5-160-12.5 MG [EXFORGE HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 5-160-12.5 MG [EXFORGE HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
AMLOD-VALSA-HCTZ 5-160-25 MG [EXFORGE HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 5-160-25 MG [EXFORGE HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 2.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMLODIPINE BESYLATE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
Amlodipine-Atorvastatin 10-10 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 10-10 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 10-20 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 10-20 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 10-40 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 10-40 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 10-80 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 10-80 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Amlodipine-Atorvastatin 2.5-10 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-10 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 2.5-20 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-20 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 2.5-40 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-40 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-10 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-10 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-20 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-20 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-40 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-40 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-80 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-80 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMLODIPINE-BENAZEPRIL 10-40 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 10-40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
AMLODIPINE-BENAZEPRIL 5-40 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 5-40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
AMLODIPINE-VALSARTAN 10-160 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 10-160 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMLODIPINE-VALSARTAN 10-320 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 10-320 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE-VALSARTAN 5-160 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 5-160 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
AMLODIPINE-VALSARTAN 5-320 MG ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 5-320 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
AMMONIUM CHLORIDE 5 MEQ/ML ![Compare how all Medicare Part D PDP plans in PA cover AMMONIUM CHLORIDE 5 MEQ/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMMONIUM LACTATE 12% CREAM ![Compare how all Medicare Part D PDP plans in PA cover AMMONIUM LACTATE 12% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in PA cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX TR-K CLV 500-125 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-K CLV 500-125 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOX-CLAV 200-28.5 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 200-28.5 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 125MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 125MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 250MG 500 CHEWABLE TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 250MG 500 CHEWABLE TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 500MG 500 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 500MG 500 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN 875MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 875MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPHETAMINE SALT COMBO 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
AMPHETAMINE SALT COMBO 15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
AMPHETAMINE SALT COMBO 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
AMPHETAMINE SALT COMBO 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPHETAMINE SALTS 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALTS 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
AMPHETAMINE SALTS 5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALTS 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:60 /30Days |
amphotericin b 50mg/10mL 10 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover amphotericin b 50mg/10mL 10 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in PA cover Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN CAPSULES 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN CAPSULES 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN CAPSULES 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN FOR INJECTION POWDER ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN FOR INJECTION POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN POWDER FOR INJECTION 1 GM/ML ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN POWDER FOR INJECTION 1 GM/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN-SULBACTAM 15 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN-SULBACTAM 15 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN-SULBACTAM 3 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN-SULBACTAM 3 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPICILLIN-SULBACTAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN-SULBACTAM FOR INJECTION .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AMPYRA ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPYRA ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
ANADROL-50 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ANADROL-50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Anastrozole 1mg/1 90 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Anastrozole 1mg/1 90 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ANDROGEL 1.62% (1.25G) GEL PCKT ![Compare how all Medicare Part D PDP plans in PA cover ANDROGEL 1.62% (1.25G) GEL PCKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
ANDROGEL 1.62% (2.5G) GEL PCKT ![Compare how all Medicare Part D PDP plans in PA cover ANDROGEL 1.62% (2.5G) GEL PCKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
ANDROGEL 1% (50MG) GEL PACKET ![Compare how all Medicare Part D PDP plans in PA cover ANDROGEL 1% (50MG) GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
Androgel 10mg/g 30 PACKET in 1 CARTON / 2.5 g in 1 PACKET ![Compare how all Medicare Part D PDP plans in PA cover Androgel 10mg/g 30 PACKET in 1 CARTON / 2.5 g in 1 PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP ![Compare how all Medicare Part D PDP plans in PA cover Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
ANDROID 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ANDROID 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ANORO ELLIPTA 62.5-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover ANORO ELLIPTA 62.5-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Apexicon E 0.05% Cream ![Compare how all Medicare Part D PDP plans in PA cover Apexicon E 0.05% Cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
APIDRA 100 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover APIDRA 100 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APIDRA SOLOSTAR 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in PA cover APIDRA SOLOSTAR 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APLENZIN ER 174 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 174 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | S |
APLENZIN ER 348 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 348 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | S |
APLENZIN ER 522 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 522 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | S |
APOKYN 30 MG/3 ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover APOKYN 30 MG/3 ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER per CARTON / 10 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in PA cover Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER per CARTON / 10 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PA cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
APTIOM 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APTIOM 400 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APTIOM 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APTIOM 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ARALAST NP 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARALAST NP 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARANESP 10 MCG/0.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 10 MCG/0.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 200MCG/0.4ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 200MCG/0.4ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 200MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 200MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 300MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 300MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 500MCG/1ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 500MCG/1ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 60MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 60MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ARCALYST INJECTION 220MG/VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARCALYST INJECTION 220MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
ARGATROBAN 100mg/mL 1 VIAL per CARTON / 2.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARGATROBAN 100mg/mL 1 VIAL per CARTON / 2.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Argatroban 125mg/125mL 2 VIAL, SINGLE-USE per CARTON / 125 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in PA cover Argatroban 125mg/125mL 2 VIAL, SINGLE-USE per CARTON / 125 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE 10 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 10 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE 15 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 15 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE 2 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 2 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE 20 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 20 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE 30 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 30 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARIPIPRAZOLE 5 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 5 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE ODT 10 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE ODT 10 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARIPIPRAZOLE ODT 15 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE ODT 15 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ARISTADA ER 441 MG/1.6 ML SYRN ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 441 MG/1.6 ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ARISTADA ER 662 MG/2.4 ML SYRN ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 662 MG/2.4 ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
ARISTADA ER 882 MG/3.2 ML SYRN ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 882 MG/3.2 ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Armodafinil 150 MG TABLET [NUVIGIL] ![Compare how all Medicare Part D PDP plans in PA cover Armodafinil 150 MG TABLET [NUVIGIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Armodafinil 200 MG TABLET [NUVIGIL] ![Compare how all Medicare Part D PDP plans in PA cover Armodafinil 200 MG TABLET [NUVIGIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Armodafinil 250 MG TABLET [NUVIGIL] ![Compare how all Medicare Part D PDP plans in PA cover Armodafinil 250 MG TABLET [NUVIGIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Armodafinil 50 MG TABLET [NUVIGIL] ![Compare how all Medicare Part D PDP plans in PA cover Armodafinil 50 MG TABLET [NUVIGIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
ARRANON 250MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARRANON 250MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Ashlyna 0.15-0.03-0.01 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Ashlyna 0.15-0.03-0.01 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ASPIRIN-DIPYRIDAM ER 25-200 MG [Aggrenox] ![Compare how all Medicare Part D PDP plans in PA cover ASPIRIN-DIPYRIDAM ER 25-200 MG [Aggrenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE ![Compare how all Medicare Part D PDP plans in PA cover ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P Q:180 /30Days |
ASTAGRAF XL 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ASTAGRAF XL 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ASTAGRAF XL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
ATENOLOL 100 MG100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL 100 MG100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATENOLOL 25 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL 25 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATENOLOL TABLET USP 50MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL TABLET USP 50MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATENOLOL-CHLORTHALIDONE 100-25 ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL-CHLORTHALIDONE 100-25.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATGAM 50MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in PA cover ATGAM 50MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
ATORVASTATIN 10 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 10 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ATORVASTATIN 20 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 20 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ATORVASTATIN 40 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 40 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ATORVASTATIN 80 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 80 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ATOVAQUONE 750 MG/5 ML SUSP [Mepron] ![Compare how all Medicare Part D PDP plans in PA cover ATOVAQUONE 750 MG/5 ML SUSP [Mepron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone] ![Compare how all Medicare Part D PDP plans in PA cover Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Atovaquone-Proguanil 62.5-25 [Malarone] ![Compare how all Medicare Part D PDP plans in PA cover Atovaquone-Proguanil 62.5-25 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
ATROPINE 0.05MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ATROPINE 0.05MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATROPINE 0.1MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ATROPINE 0.1MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Atropine 1% Eye Drops ![Compare how all Medicare Part D PDP plans in PA cover Atropine 1% Eye Drops.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in PA cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | Q:26 /30Days |
AUBRA-28 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AUBRA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AURYXIA 210 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AURYXIA 210 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AVASTIN 100MG/4ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover AVASTIN 100MG/4ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AVASTIN 400 MG/16 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover AVASTIN 400 MG/16 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AVELOX IV 400MG/250ML ![Compare how all Medicare Part D PDP plans in PA cover AVELOX IV 400MG/250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AVITA 0.025% CREAM ![Compare how all Medicare Part D PDP plans in PA cover AVITA 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Avita 0.25mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Avita 0.25mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AVODART 0.5MG SOFTGEL ![Compare how all Medicare Part D PDP plans in PA cover AVODART 0.5MG SOFTGEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AVONEX ADMIN PACK 30 MCG VL ![Compare how all Medicare Part D PDP plans in PA cover AVONEX ADMIN PACK 30 MCG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | Q:4 /28Days |
AVONEX PEN 30 MCG/0.5 ML KIT ![Compare how all Medicare Part D PDP plans in PA cover AVONEX PEN 30 MCG/0.5 ML KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | Q:1 /28Days |
AVONEX PREFILLED SYR 30 MCG KT ![Compare how all Medicare Part D PDP plans in PA cover AVONEX PREFILLED SYR 30 MCG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | Q:1 /28Days |
AVYCAZ 2.5 GRAM VIAL ![Compare how all Medicare Part D PDP plans in PA cover AVYCAZ 2.5 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AXIRON 30mg/1.5mL 1 BOTTLE, WITH APPLICATOR per CARTON / 90 mL in 1 BOTTLE, WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in PA cover AXIRON 30mg/1.5mL 1 BOTTLE, WITH APPLICATOR per CARTON / 90 mL in 1 BOTTLE, WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
Azacitidine 100 mg vial [Vidaza] ![Compare how all Medicare Part D PDP plans in PA cover Azacitidine 100 mg vial [Vidaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
AZASAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZASAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AZASAN 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZASAN 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P |
AZASITE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover AZASITE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AZATHIOPRINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZATHIOPRINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
AZATHIOPRINE SODIUM 100 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover AZATHIOPRINE SODIUM 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZELASTINE 0.15% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover AZELASTINE 0.15% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZELASTINE 137 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover AZELASTINE 137 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZELEX 20% CREAM 30GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover AZELEX 20% CREAM 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AZILECT 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZILECT 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AZILECT 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZILECT 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AZITHROMYCIN 1 GM PWD PACKET ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 1 GM PWD PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZITHROMYCIN 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Azithromycin 200mg/5mL 22.5 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Azithromycin 200mg/5mL 22.5 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Azithromycin 600mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Azithromycin 600mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
Azithromycin i.v. 500 mg vial ![Compare how all Medicare Part D PDP plans in PA cover Azithromycin i.v. 500 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in PA cover AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None |
AZTREONAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover AZTREONAM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$9.00 | $18.00 | None |