2018 Medicare Part D Plan Formulary Information |
Express Scripts Medicare - Saver (PDP) (S5660-247-0)
Benefit Details
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The Express Scripts Medicare - Saver (PDP) (S5660-247-0) Formulary Drugs Starting with the Letter S in CMS PDP Region 31 which includes: ID UT Plan Monthly Premium: $22.60 Deductible: $405 Qualifies for LIS: No |
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | P |
SANTYL OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover SANTYL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SAPHRIS 10 MG TAB SL BLK CHERY ![Compare how all Medicare Part D PDP plans in UT cover SAPHRIS 10 MG TAB SL BLK CHERY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:62 /31Days |
SAPHRIS 2.5 MG TAB SL BLK CHRY ![Compare how all Medicare Part D PDP plans in UT cover SAPHRIS 2.5 MG TAB SL BLK CHRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:248 /31Days |
SAPHRIS 5 MG TAB SL BLK CHERRY ![Compare how all Medicare Part D PDP plans in UT cover SAPHRIS 5 MG TAB SL BLK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:124 /31Days |
SCOPOLAMINE 1 MG/3 DAY PATCH [Transderm Scop] ![Compare how all Medicare Part D PDP plans in UT cover SCOPOLAMINE 1 MG/3 DAY PATCH [Transderm Scop].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELZENTRY 20 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 20 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SELZENTRY 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SELZENTRY 75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in UT cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:60 /30Days |
SERTRALINE 20 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE 20 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SERTRALINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:62 /31Days |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:248 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:124 /31Days |
SETLAKIN 0.15 MG-0.03 MG TAB ![Compare how all Medicare Part D PDP plans in UT cover SETLAKIN 0.15 MG-0.03 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SEVELAMER 0.8 GM POWDER PACKET [RENVELA] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER 0.8 GM POWDER PACKET [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SEVELAMER 2.4 GM POWDER PACKET POWD PACK [Renvela] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER 2.4 GM POWDER PACKET POWD PACK [Renvela].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SEVELAMER CARBONATE 800 MG TAB [RENVELA] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER CARBONATE 800 MG TAB [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SHINGRIX VIAL KIT ![Compare how all Medicare Part D PDP plans in UT cover SHINGRIX VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
Signifor .3 mg/mL ![Compare how all Medicare Part D PDP plans in UT cover Signifor .3 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Signifor .6 mg/mL ![Compare how all Medicare Part D PDP plans in UT cover Signifor .6 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Signifor .9 mg/mL ![Compare how all Medicare Part D PDP plans in UT cover Signifor .9 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SILDENAFIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SILDENAFIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | P Q:93 /31Days |
SILVER SULFADIAZINE 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover SILVER SULFADIAZINE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMBRINZA 1%-0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover SIMBRINZA 1%-0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SIMULECT 20MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SIMULECT 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | P |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:31 /31Days |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:31 /31Days |
SIMVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:31 /31Days |
SIMVASTATIN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:31 /31Days |
SIMVASTATIN 80 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | Q:31 /31Days |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | P |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE 0.45% TUBEX ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.45% TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SODIUM CHLORIDE 0.9% IRRIG. ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.9% IRRIG..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SODIUM CHLORIDE 0.9% IV SOLN ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.9% IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
Sodium Chloride 3g/100mL ![Compare how all Medicare Part D PDP plans in UT cover Sodium Chloride 3g/100mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SODIUM CL 2.5 MEQ/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CL 2.5 MEQ/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SODIUM POLYSTYRENE SULF POWDER ![Compare how all Medicare Part D PDP plans in UT cover SODIUM POLYSTYRENE SULF POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SOLTAMOX 20 MG/10 ML SOLN Solution ![Compare how all Medicare Part D PDP plans in UT cover SOLTAMOX 20 MG/10 ML SOLN Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SOLU CORTEF 250MG/VIAL INJECTION ![Compare how all Medicare Part D PDP plans in UT cover SOLU CORTEF 250MG/VIAL INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SOMATULINE DEPOT 120 MG/0.5 ML ![Compare how all Medicare Part D PDP plans in UT cover SOMATULINE DEPOT 120 MG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SOMATULINE DEPOT 60 MG/0.2 ML ![Compare how all Medicare Part D PDP plans in UT cover SOMATULINE DEPOT 60 MG/0.2 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMATULINE DEPOT 90 MG/0.3 ML ![Compare how all Medicare Part D PDP plans in UT cover SOMATULINE DEPOT 90 MG/0.3 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SOMAVERT 25 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 25 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SOMAVERT 30 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 30 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SOTALOL 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTALOL 240 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 240 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SOTALOL 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SOTALOL AF 120 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL AF 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SOTYLIZE 5 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SOTYLIZE 5 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SPIRIVA 18 MCG CP-HANDIHALER ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA 18 MCG CP-HANDIHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:90 /90Days |
SPIRIVA RESPIMAT 1.25 MCG INH ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA RESPIMAT 1.25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:4 /30Days |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:4 /30Days |
SPIRONOLACTONE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
SPIRONOLACTONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
SPIRONOLACTONE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
SPIRONOLACTONE-HCTZ 25-25 TAB ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE-HCTZ 25-25 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SPRITAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SPRITAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SPRITAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SPRITAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:31 /31Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:62 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SPS 15 GM/60 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover SPS 15 GM/60 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in UT cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in UT cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STALEVO 200 50-200-200 TABLET ![Compare how all Medicare Part D PDP plans in UT cover STALEVO 200 50-200-200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STALEVO 50 TABLET ![Compare how all Medicare Part D PDP plans in UT cover STALEVO 50 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STAVUDINE 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover STAVUDINE 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STAVUDINE 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover STAVUDINE 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STAVUDINE CAPSULES 30MG 60 BOT ![Compare how all Medicare Part D PDP plans in UT cover STAVUDINE CAPSULES 30MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STAVUDINE CAPSULES 40MG 60 BOT ![Compare how all Medicare Part D PDP plans in UT cover STAVUDINE CAPSULES 40MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in UT cover Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:84 /28Days |
STRENSIQ 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover STRENSIQ 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STRENSIQ 80 MG/0.8 ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover STRENSIQ 80 MG/0.8 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in UT cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in UT cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SUBOXONE 12 MG-3 MG SL FILM ![Compare how all Medicare Part D PDP plans in UT cover SUBOXONE 12 MG-3 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
Suboxone 2; 0.5mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in UT cover Suboxone 2; 0.5mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:372 /31Days |
SUBOXONE 4 MG-1 MG SL FILM ![Compare how all Medicare Part D PDP plans in UT cover SUBOXONE 4 MG-1 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:93 /31Days |
Suboxone 8; 2mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in UT cover Suboxone 8; 2mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:93 /31Days |
SUCRAID 8500[iU]/mL ![Compare how all Medicare Part D PDP plans in UT cover SUCRAID 8500[iU]/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SULFACETAMIDE SOD 10% TOP SUSP ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE SOD 10% TOP SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE SODIUM OPHTHALMIC SOLUTION USP 10% 15 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
Sulfadiazine 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Sulfadiazine 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SULFAMETHOXAZOLE-TMP INJ VIAL ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP INJ VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SULFAMETHOXAZOLE-TMP SS TABLET [Septra] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP SS TABLET [Septra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SULFAMETHOXAZOLE-TMP SUSP Oral Suspension [Sultrex Pediatric] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP SUSP Oral Suspension [Sultrex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SULFAMYLON 8.5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover SULFAMYLON 8.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SULFASALAZINE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SULFASALAZINE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFASALAZINE DR 500 MG TAB ![Compare how all Medicare Part D PDP plans in UT cover SULFASALAZINE DR 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | None |
SULINDAC 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SULINDAC 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
SULINDAC 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SULINDAC 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.00 | None |
Sumatriptan 20 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan 20 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | Q:18 /28Days |
SUMATRIPTAN 4 MG/0.5 ML CART ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 4 MG/0.5 ML CART.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:8 /28Days |
Sumatriptan 4 mg/0.5 ml inject ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan 4 mg/0.5 ml inject.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:8 /28Days |
Sumatriptan 5 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan 5 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | Q:36 /28Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:8 /28Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:8 /28Days |
Sumatriptan 6 mg/0.5 ml vial ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan 6 mg/0.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:8 /28Days |
SUMATRIPTAN SUCC 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN SUCC 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | Q:18 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN SUCC 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN SUCC 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | Q:18 /28Days |
Sumatriptan Succinate 25mg/1 9 BLISTER PACK per CARTON / 9 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan Succinate 25mg/1 9 BLISTER PACK per CARTON / 9 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$4.00 | $8.00 | Q:18 /28Days |
SUPRAX 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SUTENT 25mg/1 28 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SUTENT 25mg/1 28 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:62 /31Days |
SUTENT 37.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUTENT 37.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:62 /31Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYLATRON 200 MCG KIT ![Compare how all Medicare Part D PDP plans in UT cover SYLATRON 200 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYLATRON 300 MCG KIT ![Compare how all Medicare Part D PDP plans in UT cover SYLATRON 300 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYLATRON 600 MCG KIT ![Compare how all Medicare Part D PDP plans in UT cover SYLATRON 600 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYLVANT 100 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYLVANT 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SYLVANT 400 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYLVANT 400 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in UT cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:10 /30Days |
SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER ![Compare how all Medicare Part D PDP plans in UT cover SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:10 /30Days |
SYMDEKO 100/150 MG-150 MG TABS ![Compare how all Medicare Part D PDP plans in UT cover SYMDEKO 100/150 MG-150 MG TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
SYMFI 600-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYMFI 600-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SYMFI LO 400-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYMFI LO 400-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:11 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:6 /30Days |
SYNAGIS 100 MG/1 ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYNAGIS 100 MG/1 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYNAGIS 50MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYNAGIS 50MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | None |
SYNERCID 500MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYNERCID 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
SYNJARDY 12.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 12.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNJARDY 12.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 12.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNJARDY 5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNJARDY XR 10-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 10-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNJARDY XR 12.5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 12.5-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNJARDY XR 25-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 25-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNJARDY XR 5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 5-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
18% | 18% | Q:62 /31Days |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | P |
SYPRINE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SYPRINE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | N/A | P Q:248 /31Days |