2016 Medicare Part D Plan Formulary Information |
UPMC for Life PPO High Deductible with Rx (PPO) (H5533-006-0)
Benefit Details
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The UPMC for Life PPO High Deductible with Rx (PPO) (H5533-006-0) Formulary Drugs Starting with the Letter B in Lancaster County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $43.00 Deductible: $0 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in PA cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in PA cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in PA cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BACLOFEN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BACLOFEN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in PA cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | P |
BANZEL TABLET 400MG ![Compare how all Medicare Part D PDP plans in PA cover BANZEL TABLET 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BEKYREE 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in PA cover BEKYREE 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BELEODAQ 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover BELEODAQ 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | None |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 20mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 20mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Select Care Drugs |
$0.00 | $0.00 | None |
BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BENLYSTA 400 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover BENLYSTA 400 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BENTYL INJECTION 20MG/2ML AMP ![Compare how all Medicare Part D PDP plans in PA cover BENTYL INJECTION 20MG/2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BENZTROPINE 2 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE 2 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BENZTROPINE MESYLATE 0.5 MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE MESYLATE 0.5 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Benztropine Mesylate 1mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Benztropine Mesylate 1mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BENZTROPINE MESYLATE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE MESYLATE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in PA cover BERINERT 500 UNIT KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Betamethasone Dipropionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone Dipropionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Betamethasone DP 0.05% ointment ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone DP 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BETAMETHASONE DP AUG 0.05% OIN ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% OIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BETAMETHASONE VALERATE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
BETAMETHASONE VALERATE CREAM ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | S Q:14 /28Days |
Betaxolol 10mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Betaxolol 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Betaxolol 20mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Betaxolol 20mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Betaxolol hcl 0.5% eye drop ![Compare how all Medicare Part D PDP plans in PA cover Betaxolol hcl 0.5% eye drop.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Bethanechol 10 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Bethanechol 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Bethanechol 5 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Bethanechol 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BETHANECHOL CHLORIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL CHLORIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BETHKIS 300 MG/4 ML AMPULE ![Compare how all Medicare Part D PDP plans in PA cover BETHKIS 300 MG/4 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P Q:224 /56Days |
BETIMOL 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BETIMOL 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in PA cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
Bicalutamide 50mL/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Bicalutamide 50mL/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in PA cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BICNU 100 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover BICNU 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
BIMATOPROST 0.03% EYE DROPS [Lumigan] ![Compare how all Medicare Part D PDP plans in PA cover BIMATOPROST 0.03% EYE DROPS [Lumigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | S |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BIVIGAM LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover BIVIGAM LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in PA cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BLEPHAMIDE 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BLEPHAMIDE 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in PA cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BLISOVI 24 FE TABLET ![Compare how all Medicare Part D PDP plans in PA cover BLISOVI 24 FE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BLISOVI FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in PA cover BLISOVI FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BLISOVI FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in PA cover BLISOVI FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PA cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BOSULIF 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
BOTOX 100UNITS VIAL ![Compare how all Medicare Part D PDP plans in PA cover BOTOX 100UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | P Q:4 /84Days |
BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | P Q:2 /84Days |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days |
Brimonidine Tartrate 1.5mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Brimonidine Tartrate 1.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in PA cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 10 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 10 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 50 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 50 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BROMFENAC SODIUM 0.09% EYE DRP ![Compare how all Medicare Part D PDP plans in PA cover BROMFENAC SODIUM 0.09% EYE DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Bromocriptine mesylate 2.5mg/1 24 BOTTLE per CARTON / 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Bromocriptine mesylate 2.5mg/1 24 BOTTLE per CARTON / 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in PA cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | P |
BUDESONIDE 0.25 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 0.25 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 0.5 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | P |
BUDESONIDE 1 MG/2 ML INH SUSP ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 1 MG/2 ML INH SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | P |
Budesonide 3mg 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Budesonide 3mg 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | None |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUMETANIDE 0.5 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 0.5 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUMETANIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUMETANIDE 2 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 2 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPHENYL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPHENYL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:267 /30Days |
Buprenorphine HCl 2mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Buprenorphine HCl 2mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | P Q:60 /30Days |
Buprenorphine HCl 8mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Buprenorphine HCl 8mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | P Q:60 /30Days |
BUPROBAN ER 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROBAN ER 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bupropion Hydrochloride 100mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Bupropion Hydrochloride 100mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
Bupropion Hydrochloride 150mg/1 100 TABLET, ER in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Bupropion Hydrochloride 150mg/1 100 TABLET, ER in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUPROPION HYDROCHLORIDE 75mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HYDROCHLORIDE 75mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HYDROCHLORIDE 10 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | None |
BUSULFEX 6mg/mL ![Compare how all Medicare Part D PDP plans in PA cover BUSULFEX 6mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | None |
BUTALBITAL COMP-CODEINE #3 CAP ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL COMP-CODEINE #3 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | Q:1334 /30Days |
BUTALBITAL/CAFFEINE/ACETAMINOPH/CODEIN ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL/CAFFEINE/ACETAMINOPH/CODEIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Butorphanol 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Butorphanol 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | Q:720 /30Days |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in PA cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:8 /30Days |
Butorphanol 2 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Butorphanol 2 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$14.00 | $28.00 | Q:360 /30Days |
BYDUREON 2 MG PEN INJECT ![Compare how all Medicare Part D PDP plans in PA cover BYDUREON 2 MG PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:4 /28Days |
BYDUREON 2 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover BYDUREON 2 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:4 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in PA cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:2 /28Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in PA cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:1 /28Days |