2018 Medicare Part D Plan Formulary Information |
Advantra (PPO) (H1608-013-0)
Benefit Details
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The Advantra (PPO) (H1608-013-0) Formulary Drugs Starting with the Letter I in Jefferson County, MO: CMS MA Region 15 which includes: MO Plan Monthly Premium: $56.00 Deductible: $0 |
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE 3 MG/3 ML VIAL [Boniva] ![Compare how all Medicare Part D PDP plans in MO cover IBANDRONATE 3 MG/3 ML VIAL [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | Q:3 /90Days |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] ![Compare how all Medicare Part D PDP plans in MO cover IBANDRONATE SODIUM 150 MG TABLET [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | Q:1 /30Days |
IBRANCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover IBRANCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IBRANCE 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover IBRANCE 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IBRANCE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover IBRANCE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
IBUPROFEN 400 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IBUPROFEN 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
IBUPROFEN 600 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in MO cover IBUPROFEN 600 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
IBUPROFEN 600mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover IBUPROFEN 600mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
IBUPROFEN 800 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in MO cover IBUPROFEN 800 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IBUPROFEN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IBUPROFEN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
ICLUSIG 15 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ICLUSIG 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ICLUSIG 45 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ICLUSIG 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IDARUBICIN HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover IDARUBICIN HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
IDHIFA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IDHIFA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
IDHIFA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IDHIFA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
IFOSFAMIDE FOR INFECTION 1 GM ![Compare how all Medicare Part D PDP plans in MO cover IFOSFAMIDE FOR INFECTION 1 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ILEVRO 0.3% OPHTH DROPS ![Compare how all Medicare Part D PDP plans in MO cover ILEVRO 0.3% OPHTH DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
IMATINIB MESYLATE 100 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in MO cover IMATINIB MESYLATE 100 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
IMATINIB MESYLATE 400 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in MO cover IMATINIB MESYLATE 400 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
IMBRUVICA 140 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 140 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMBRUVICA 140 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 140 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMBRUVICA 280 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 280 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMBRUVICA 420 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 420 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMBRUVICA 560 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 560 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMBRUVICA 70 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover IMBRUVICA 70 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMFINZI 120 MG/2.4 ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover IMFINZI 120 MG/2.4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMFINZI 500 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover IMFINZI 500 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | P |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | P |
IMIPRAMINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | P |
IMIPRAMINE PAMOATE 100MG CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE PAMOATE 100MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMIPRAMINE PAMOATE 125MG CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE PAMOATE 125MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
IMIPRAMINE PAMOATE 150MG CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE PAMOATE 150MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
IMIPRAMINE PAMOATE 75MG CAPSULES ![Compare how all Medicare Part D PDP plans in MO cover IMIPRAMINE PAMOATE 75MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
IMIQUIMOD 5% CREAM PACKET ![Compare how all Medicare Part D PDP plans in MO cover IMIQUIMOD 5% CREAM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
IMITREX 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:9 /30Days |
IMITREX 20MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 20MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:12 /30Days |
IMITREX 25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:9 /30Days |
IMITREX 4 MG/0.5 ML PEN INJECT ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 4 MG/0.5 ML PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:4 /30Days |
IMITREX 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:9 /30Days |
IMITREX 5MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 5MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:12 /30Days |
IMITREX 6MG/0.5ML SYRNG KIT ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 6MG/0.5ML SYRNG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMITREX 6MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover IMITREX 6MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:4 /30Days |
IMOVAX RABIES VACCINE ![Compare how all Medicare Part D PDP plans in MO cover IMOVAX RABIES VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
IMURAN 50 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IMURAN 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in MO cover Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INCRUSE ELLIPTA 62.5 MCG INH ![Compare how all Medicare Part D PDP plans in MO cover INCRUSE ELLIPTA 62.5 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
INDAPAMIDE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INDAPAMIDE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
INDERAL LA 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDERAL LA 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INDERAL LA 160 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDERAL LA 160 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INDERAL LA 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDERAL LA 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INDERAL LA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDERAL LA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT ![Compare how all Medicare Part D PDP plans in MO cover INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INDOMETHACIN 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDOMETHACIN 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INDOMETHACIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDOMETHACIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INDOMETHACIN ER 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INDOMETHACIN ER 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INFANRIX DTAP VIAL ![Compare how all Medicare Part D PDP plans in MO cover INFANRIX DTAP VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
INLYTA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INLYTA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INLYTA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INLYTA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INNOPRAN XL 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INNOPRAN XL 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INNOPRAN XL 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INNOPRAN XL 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INSPRA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INSPRA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INSPRA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INSPRA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Intelence 200mg/1 ![Compare how all Medicare Part D PDP plans in MO cover Intelence 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
INTELENCE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INTELENCE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INTERMEZZO 1.75 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in MO cover INTERMEZZO 1.75 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:30 /30Days |
INTERMEZZO 3.5 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in MO cover INTERMEZZO 3.5 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:30 /30Days |
INTRALIPID 20% IV FAT EMUL EMULSION ![Compare how all Medicare Part D PDP plans in MO cover INTRALIPID 20% IV FAT EMUL EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INTRALIPID 30% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in MO cover INTRALIPID 30% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
INTRON A 18 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in MO cover INTRON A 18 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INTRON A 25 MILLION UNIT/2.5ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover INTRON A 25 MILLION UNIT/2.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INTRON A 50 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in MO cover INTRON A 50 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin] ![Compare how all Medicare Part D PDP plans in MO cover INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
Intuniv 1 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Intuniv 1 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
Intuniv 2 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Intuniv 2 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
Intuniv 3 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Intuniv 3 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
Intuniv 4 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Intuniv 4 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in MO cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in MO cover INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in MO cover INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:60 /30Days |
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in MO cover INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
INVEGA ER 1.5mg/ 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover INVEGA ER 1.5mg/ 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | S Q:30 /30Days |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in MO cover Invega Sustenna 117 mg/0.75mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Invega Sustenna 156 mg/mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in MO cover Invega Sustenna 156 mg/mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in MO cover Invega Sustenna 234 mg/1.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:2 /28Days |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in MO cover Invega Sustenna 39 mg/0.25mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in MO cover Invega Sustenna 78 mg/0.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
INVEGA TRINZA 273 MG/0.875 ML ![Compare how all Medicare Part D PDP plans in MO cover INVEGA TRINZA 273 MG/0.875 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /90Days |
INVEGA TRINZA 410 MG/1.315 ML ![Compare how all Medicare Part D PDP plans in MO cover INVEGA TRINZA 410 MG/1.315 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /90Days |
INVEGA TRINZA 546 MG/1.75 ML ![Compare how all Medicare Part D PDP plans in MO cover INVEGA TRINZA 546 MG/1.75 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:2 /90Days |
INVEGA TRINZA 819 MG/2.625 ML ![Compare how all Medicare Part D PDP plans in MO cover INVEGA TRINZA 819 MG/2.625 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:3 /90Days |
INVIRASE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover INVIRASE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
INVOKAMET 150-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET 150-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVOKAMET 150-500 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET 150-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
INVOKAMET 50-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET 50-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
INVOKAMET 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:120 /30Days |
INVOKAMET XR 150-1,000 MG TAB ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET XR 150-1,000 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
INVOKAMET XR 150-500 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET XR 150-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
INVOKAMET XR 50-1,000 MG TAB ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET XR 50-1,000 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
INVOKAMET XR 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKAMET XR 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:120 /30Days |
INVOKANA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKANA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:90 /30Days |
INVOKANA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover INVOKANA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in MO cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML ![Compare how all Medicare Part D PDP plans in MO cover IPRAT-ALBUT 0.5-3(2.5) MG/3 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | P |
IPRATROPIUM 0.06% SPRAY ![Compare how all Medicare Part D PDP plans in MO cover IPRATROPIUM 0.06% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | Q:45 /30Days |
IPRATROPIUM BR 0.02% SOLN ![Compare how all Medicare Part D PDP plans in MO cover IPRATROPIUM BR 0.02% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | P |
IPRATROPIUM BROMIDE NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MO cover IPRATROPIUM BROMIDE NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | Q:30 /30Days |
IRBESARTAN 150 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in MO cover IRBESARTAN 150 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | Q:30 /30Days |
IRBESARTAN 300 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in MO cover IRBESARTAN 300 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | Q:30 /30Days |
IRBESARTAN 75 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in MO cover IRBESARTAN 75 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | Q:30 /30Days |
IRBESARTAN-HCTZ 150-12.5 MG TB [Avalide] ![Compare how all Medicare Part D PDP plans in MO cover IRBESARTAN-HCTZ 150-12.5 MG TB [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | Q:30 /30Days |
IRBESARTAN-HCTZ 300-12.5 MG TB [Avalide] ![Compare how all Medicare Part D PDP plans in MO cover IRBESARTAN-HCTZ 300-12.5 MG TB [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | Q:30 /30Days |
IRESSA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover IRESSA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
IRINOTECAN HCL 100 MG/5 ML VL ![Compare how all Medicare Part D PDP plans in MO cover IRINOTECAN HCL 100 MG/5 ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISENTRESS 100 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in MO cover ISENTRESS 100 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ISENTRESS 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover ISENTRESS 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ISENTRESS 25 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in MO cover ISENTRESS 25 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ISENTRESS HD 600 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISENTRESS HD 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ISIBLOOM 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISIBLOOM 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOLYTE S IV SOLUTION-EXCEL ![Compare how all Medicare Part D PDP plans in MO cover ISOLYTE S IV SOLUTION-EXCEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISONIAZID 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISONIAZID 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
ISONIAZID 300 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISONIAZID 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MO cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISONIAZID INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in MO cover ISONIAZID INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISORDIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISORDIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISORDIL TITRADOSE 5 MG TAB ![Compare how all Medicare Part D PDP plans in MO cover ISORDIL TITRADOSE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOSORBIDE DINITRATE 40MG TABLETS ER ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE DINITRATE 40MG TABLETS ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISOSORBIDE DN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE DN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
ISOSORBIDE DN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE DN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
ISOSORBIDE DN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE DN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
ISOSORBIDE DN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE DN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE MN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE MN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
ISOSORBIDE MN ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE MN ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISOSORBIDE MN ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE MN ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISOSORBIDE MONONITRATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE MONONITRATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | N/A | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in MO cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOTONIC GENTAMICIN 100 MG/100 ML ![Compare how all Medicare Part D PDP plans in MO cover ISOTONIC GENTAMICIN 100 MG/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOTONIC GENTAMICIN 80 MG/50 ML ![Compare how all Medicare Part D PDP plans in MO cover ISOTONIC GENTAMICIN 80 MG/50 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOTRETINOIN 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in MO cover ISOTRETINOIN 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOTRETINOIN 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in MO cover ISOTRETINOIN 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISOTRETINOIN 30 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in MO cover ISOTRETINOIN 30 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOTRETINOIN 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in MO cover ISOTRETINOIN 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | N/A | None |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in MO cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
ISTODAX 10 MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover ISTODAX 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ITRACONAZOLE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover ITRACONAZOLE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] ![Compare how all Medicare Part D PDP plans in MO cover IVERMECTIN 3 MG TABLET [Stromectol, Sklice].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML ![Compare how all Medicare Part D PDP plans in MO cover IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |