2018 Medicare Part D Plan Formulary Information |
Aetna Medicare Premier Plan (PPO) (H5521-140-0)
Benefit Details
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The Aetna Medicare Premier Plan (PPO) (H5521-140-0) Formulary Drugs Starting with the Letter O in York County, SC: CMS MA Region 8 which includes: SC Plan Monthly Premium: $0.00 Deductible: $150 |
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCELLA 3MG/0.03MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OCELLA 3MG/0.03MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
OCTAGAM 10% VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTAGAM 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OCTAGAM 5% VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTAGAM 5% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OCTREOTIDE 1,000 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE 1,000 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OCTREOTIDE ACET 0.05 MG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 0.05 MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OCTREOTIDE ACET 100 MCG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 100 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OCTREOTIDE ACET 200 MCG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 200 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OCTREOTIDE ACET 500 MCG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 500 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OCUFLOX 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover OCUFLOX 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in SC cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ODEFSEY TABLET ![Compare how all Medicare Part D PDP plans in SC cover ODEFSEY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | None |
ODOMZO 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ODOMZO 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OFEV 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OFEV 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OFEV 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OFEV 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OFLOXACIN 0.3 % DRP ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 0.3 % DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
OFLOXACIN 0.3% EAR DROPS ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 0.3% EAR DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OFLOXACIN 300 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OFLOXACIN 400 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
OLANZAPINE 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
OLANZAPINE 10 MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLANZAPINE 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE 2.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 2.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
OLANZAPINE 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
OLANZAPINE 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
OLANZAPINE 7.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 7.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN MEDOXOMIL 20 MG TAB [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 20 MG TAB [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN MEDOXOMIL 40 MG TAB [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 40 MG TAB [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN MEDOXOMIL 5 MG TAB [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 5 MG TAB [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN-HCTZ 20-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 20-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN-HCTZ 40-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 40-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN-HCTZ 40-25 MG TAB ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 40-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Olopatadine 2 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in SC cover Olopatadine 2 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLOPATADINE 665 MCG NASAL SPRY ![Compare how all Medicare Part D PDP plans in SC cover OLOPATADINE 665 MCG NASAL SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:31 /30Days |
OLOPATADINE HCL 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover OLOPATADINE HCL 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLUX 0.05% FOAM ![Compare how all Medicare Part D PDP plans in SC cover OLUX 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OMEGA-3 ETHYL ESTERS 1 GM CAP [Lovaza] ![Compare how all Medicare Part D PDP plans in SC cover OMEGA-3 ETHYL ESTERS 1 GM CAP [Lovaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
OMEPRAZOLE-BICARB 20-1,100 CAP [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 20-1,100 CAP [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OMEPRAZOLE-BICARB 20-1,680 PKT PACKET [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 20-1,680 PKT PACKET [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OMEPRAZOLE-BICARB 40-1,100 CAP [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 40-1,100 CAP [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OMEPRAZOLE-BICARB 40-1,680 PACKET [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 40-1,680 PACKET [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OMNARIS 50MCG SPRAY NON-AEROSOL ![Compare how all Medicare Part D PDP plans in SC cover OMNARIS 50MCG SPRAY NON-AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:13 /30Days |
OMNIPRED OPHTHALMIC SUSPENSION 1% 10 ML BOTPL ![Compare how all Medicare Part D PDP plans in SC cover OMNIPRED OPHTHALMIC SUSPENSION 1% 10 ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ONDANSETRON 4 MG/2 ML ISECURE ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON 4 MG/2 ML ISECURE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ONDANSETRON 4 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON 4 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:900 /30Days |
ONDANSETRON HCL 24 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 24 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
ONDANSETRON HCL 4 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
ONDANSETRON HCL 4 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 4 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ONDANSETRON HCL 8 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
ONDANSETRON ODT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON ODT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
ONDANSETRON ODT 8 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON ODT 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
ONFI 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONFI 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
ONFI 2.5 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in SC cover ONFI 2.5 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ONFI 20 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONFI 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ONZETRA XSAIL 11 MG ![Compare how all Medicare Part D PDP plans in SC cover ONZETRA XSAIL 11 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:16 /30Days |
OPANA 10MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OPANA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OPANA 5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OPANA 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OPDIVO 100 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover OPDIVO 100 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OPDIVO 40 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover OPDIVO 40 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
OPSUMIT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OPSUMIT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORACEA CAPSULES 40MG 30 BOT ![Compare how all Medicare Part D PDP plans in SC cover ORACEA CAPSULES 40MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
ORAPRED ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORAPRED ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ORAPRED ODT 15 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORAPRED ODT 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ORAPRED ODT 30 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORAPRED ODT 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ORAVIG 50 MG BUCCAL TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORAVIG 50 MG BUCCAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORFADIN 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORFADIN 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORFADIN 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORFADIN 4 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 4 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORFADIN 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORKAMBI 100 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 100 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
ORKAMBI 200 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 200 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
Orsythia 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in SC cover Orsythia 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
ORTHO TRI-CYCLEN LO TABLET [Trinessa Lo] ![Compare how all Medicare Part D PDP plans in SC cover ORTHO TRI-CYCLEN LO TABLET [Trinessa Lo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OSMOPREP TABLET 1.5GM ![Compare how all Medicare Part D PDP plans in SC cover OSMOPREP TABLET 1.5GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 10 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 10 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 12.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 12.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 15 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 15 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 17.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 17.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 20 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 20 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 22.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 22.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OTREXUP 25 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in SC cover OTREXUP 25 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OVIDE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in SC cover OVIDE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXACILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Oxacillin 100 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in SC cover Oxacillin 100 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Oxacillin 2000 MG Injection ![Compare how all Medicare Part D PDP plans in SC cover Oxacillin 2000 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXALIPLATIN 100 MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXALIPLATIN 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXALIPLATIN 100 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXALIPLATIN 100 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXANDROLONE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXANDROLONE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
OXANDROLONE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXANDROLONE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:120 /30Days |
OXAPROZIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXAPROZIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXAZEPAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
OXAZEPAM 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
OXAZEPAM 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXCARBAZEPINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
OXCARBAZEPINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXCARBAZEPINE 600 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
OXICONAZOLE NITRATE 1% CREAM Cream (g) [Oxistat] ![Compare how all Medicare Part D PDP plans in SC cover OXICONAZOLE NITRATE 1% CREAM Cream (g) [Oxistat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXISTAT 1% CREAM ![Compare how all Medicare Part D PDP plans in SC cover OXISTAT 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXISTAT 1% LOTION ![Compare how all Medicare Part D PDP plans in SC cover OXISTAT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXTELLAR XR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXTELLAR XR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
OXTELLAR XR 300 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXTELLAR XR 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
OXTELLAR XR 600 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXTELLAR XR 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
OXYBUTYNIN 5 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN 5 MG/5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:600 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYBUTYNIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:120 /30Days |
OXYBUTYNIN CL ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
OXYBUTYNIN CL ER 15 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
OXYBUTYNIN CL ER 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
OXYCODON-ACETAMINOPHEN 2.5-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODON-ACETAMINOPHEN 2.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODON-ACETAMINOPHEN 7.5-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODON-ACETAMINOPHEN 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 10 MG TABLET [Dazidox] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 10 MG TABLET [Dazidox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 100 MG/5 ML SOLN ORAL CONC [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 100 MG/5 ML SOLN ORAL CONC [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYCODONE HCL 15 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 15 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 20 MG TABLET [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 20 MG TABLET [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 30 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 30 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL 5 MG CAPSULE [OxyIR] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG CAPSULE [OxyIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 5 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
OXYCODONE HCL 5 MG/5 ML SOLN Solution [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG/5 ML SOLN Solution [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:5400 /30Days |
OXYCODONE HCL ER 10 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 10 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 15 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 15 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 20 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 20 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 30 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 30 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 40 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 40 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 60 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 60 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYCODONE HCL ER 80 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL ER 80 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
OXYCODONE-ACETAMINOPHEN 10-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ACETAMINOPHEN 10-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE-ACETAMINOPHEN 5-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ACETAMINOPHEN 5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYCODONE-ASPIRIN 4.8355-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ASPIRIN 4.8355-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYCODONE-IBUPROFEN 5-400 TAB ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-IBUPROFEN 5-400 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
OXYMORPHONE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYMORPHONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
oxymorphone hcl er 10 mg tab ![Compare how all Medicare Part D PDP plans in SC cover oxymorphone hcl er 10 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
OXYMORPHONE HCL ER 15 MG TAB ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 15 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
oxymorphone hcl er 20 mg tab ![Compare how all Medicare Part D PDP plans in SC cover oxymorphone hcl er 20 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
oxymorphone hcl er 30 mg tab ![Compare how all Medicare Part D PDP plans in SC cover oxymorphone hcl er 30 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
oxymorphone hcl er 40 mg tab ![Compare how all Medicare Part D PDP plans in SC cover oxymorphone hcl er 40 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
oxymorphone hcl er 5 mg tablet ![Compare how all Medicare Part D PDP plans in SC cover oxymorphone hcl er 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYMORPHONE HCL ER 7.5 MG TAB ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 7.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in SC cover OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:8 /28Days |