2018 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-266-0)
Benefit Details
 |
The Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-266-0) Formulary Drugs Starting with the Letter E in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $55.20 Deductible: $0 Qualifies for LIS: No |
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
E.E.S. 400 FILMTAB  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ECONAZOLE NITRATE 1% CREAM 85GM TUBE  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
EDARBI 40 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S |
EDARBI 80 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S |
EDARBYCLOR 40-12.5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S |
EDARBYCLOR 40-25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S |
EDURANT 27.5mg/1  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
EFAVIRENZ 200 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in LA cover EFAVIRENZ 200 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
EFAVIRENZ 50 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in LA cover EFAVIRENZ 50 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
EFAVIRENZ 600 MG TABLET [Sustiva] ![Compare how all Medicare Part D PDP plans in LA cover EFAVIRENZ 600 MG TABLET [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS  |
5 |
Specialty Tier |
33% | N/A | P |
ELIDEL 1% CREAM  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:100 /90Days |
ELIGARD 22.5 MG SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1 /90Days |
ELIGARD 30 MG SYRINGE KIT  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1 /120Days |
ELIGARD 45 MG SYRINGE KIT  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1 /180Days |
ELIGARD 7.5 MG SYRINGE KIT  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1 /30Days |
ELIQUIS 2.5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
ELIQUIS 5 MG STARTER PACK  |
4 |
Non-Preferred Drug |
50% | 50% | Q:74 /30Days |
ELIQUIS 5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:74 /30Days |
Elitek 3 KIT per CARTON / 1 KIT in 1 KIT  |
5 |
Specialty Tier |
33% | N/A | P |
ELITEK 7.5 MG VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELMIRON 100mg GELATIN COATED 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
EMCYT 140MG CAPSULE  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
EMEND 125 MG POWDER PACKET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:6 /28Days |
Emoquette 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK  |
2 |
Generic |
$10.00 | $30.00 | None |
Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy] ![Compare how all Medicare Part D PDP plans in LA cover Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
EMPLICITI 300 MG VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
EMPLICITI 400 MG VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
EMTRIVA 10MG/ML SOLUTION  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:680 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMTRIVA 200MG CAPSULE  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
ENABLEX 15 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
ENABLEX 7.5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
ENALAPRIL MALEATE 10 MG TAB  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ENALAPRIL MALEATE 2.5 MG TAB  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ENALAPRIL MALEATE 20 MG TAB  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ENALAPRIL MALEATE 5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
Enalapril Maleate and Hydrochlorothiazide 10; 25mg/1; mg/1 100 TABLET BOTTLE, PLASTIC  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ENALAPRIL-HCTZ 5-12.5 MG TAB  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ENBREL 25 MG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ENBREL 25MG KIT  |
5 |
Specialty Tier |
33% | N/A | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENBREL 50 MG/ML SURECLICK SYR  |
5 |
Specialty Tier |
33% | N/A | P Q:8 /28Days |
ENBREL 50mg/mL  |
5 |
Specialty Tier |
33% | N/A | P Q:8 /28Days |
ENDOCET 10MG-325MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:180 /30Days |
ENDOCET 5/325 TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:360 /30Days |
ENDOCET 7.5-325MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:240 /30Days |
ENGERIX B INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:3 /365Days |
ENGERIX-B 20 MCG/ML SYRN  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:8 /365Days |
ENOXAPARIN 100 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /90Days |
ENOXAPARIN 120 MG/0.8 ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:24 /90Days |
ENOXAPARIN 150 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /90Days |
ENOXAPARIN 30 MG/0.3 ML SYR  |
4 |
Non-Preferred Drug |
50% | 50% | Q:9 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENOXAPARIN 300 MG/3 ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /90Days |
ENOXAPARIN 40 MG/0.4 ML SYR  |
4 |
Non-Preferred Drug |
50% | 50% | Q:12 /90Days |
ENOXAPARIN 60 MG/0.6 ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:18 /90Days |
ENOXAPARIN 80 MG/0.8 ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:24 /90Days |
ENSKYCE 28 TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
ENTACAPONE 200 MG TABLET [Comtan Entacapone] ![Compare how all Medicare Part D PDP plans in LA cover ENTACAPONE 200 MG TABLET [Comtan Entacapone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:240 /30Days |
ENTECAVIR 0.5 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in LA cover ENTECAVIR 0.5 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
ENTECAVIR 1 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in LA cover ENTECAVIR 1 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
ENTRESTO 24 MG-26 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
ENTRESTO 49 MG-51 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
ENTRESTO 97 MG-103 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENULOSE 10 GM/15 ML SOLUTION  |
2 |
Generic |
$10.00 | $30.00 | None |
ENVARSUS XR 0.75 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
ENVARSUS XR 1 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
ENVARSUS XR 4 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P |
EPCLUSA 400 MG-100 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
EPINASTINE HCL 0.05% EYE DROPS  |
2 |
Generic |
$10.00 | $30.00 | None |
EPINEPHRINE 0.15 MG AUTO-INJCT  |
2 |
Generic |
$10.00 | $30.00 | Q:2 /30Days |
EPINEPHRINE 0.15 MG AUTO-INJECT  |
2 |
Generic |
$10.00 | $30.00 | Q:2 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT  |
2 |
Generic |
$10.00 | $30.00 | Q:2 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT  |
2 |
Generic |
$10.00 | $30.00 | Q:2 /30Days |
EPIPEN 0.3MG AUTO-INJECTOR  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:2 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPIPEN JR 0.15MG AUTO-INJCT  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:2 /30Days |
Epirubicin HCl 200 MG per 100 ML Injection  |
4 |
Non-Preferred Drug |
50% | 50% | P |
EPITOL 200MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
EPIVIR HBV 25MG/5ML TUBEX  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ERBITUX 100MG/50ML VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
ERGOLOID MESYLATES TABLETS 1MG 100 BOT  |
2 |
Generic |
$10.00 | $30.00 | P |
Ergotamine-caffeine 1-100mg tb  |
2 |
Generic |
$10.00 | $30.00 | Q:40 /28Days |
ERIVEDGE 150 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
ERLEADA 60 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
Errin 0.35 mg tablet  |
2 |
Generic |
$10.00 | $30.00 | None |
ERWINAZE 10,000 UNITS VIAL  |
5 |
Specialty Tier |
33% | N/A | P Q:60 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERY 2% PADS 2% 60 PADS JAR  |
2 |
Generic |
$10.00 | $30.00 | None |
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ERY-TAB TAB 250MG EC  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ERY-TAB TAB 333MG EC  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ERYPED 400 MG/5 ML SUSPENSION  |
5 |
Specialty Tier |
33% | N/A | None |
ERYTHROCIN 500MG ADDVNT VL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
ERYTHROCIN TAB 250MG  |
2 |
Generic |
$10.00 | $30.00 | None |
ERYTHROMYCIN 0.5% EYE OINTMENT  |
2 |
Generic |
$10.00 | $30.00 | None |
ERYTHROMYCIN 2% GEL  |
2 |
Generic |
$10.00 | $30.00 | None |
ERYTHROMYCIN 2% SOLUTION  |
2 |
Generic |
$10.00 | $30.00 | None |
ERYTHROMYCIN 500 MG FILMTAB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERYTHROMYCIN ES 400 MG TAB  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
Erythromycin Ethylsuccinate 40 MG/ML Oral Suspension  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
ERYTHROMYCIN TAB 250MG BS  |
4 |
Non-Preferred Drug |
50% | 50% | None |
ERYTHROMYCIN-BENZOYL GEL  |
2 |
Generic |
$10.00 | $30.00 | None |
ESBRIET 267 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:270 /30Days |
ESBRIET 267 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:270 /30Days |
ESBRIET 801 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ESCITALOPRAM 10 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in LA cover ESCITALOPRAM 10 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ESCITALOPRAM 20 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in LA cover ESCITALOPRAM 20 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:90 /30Days |
ESCITALOPRAM 5 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in LA cover ESCITALOPRAM 5 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro] ![Compare how all Medicare Part D PDP plans in LA cover ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:600 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESOMEPRAZOLE MAG DR 20 MG CAP [Nexium] ![Compare how all Medicare Part D PDP plans in LA cover ESOMEPRAZOLE MAG DR 20 MG CAP [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium] ![Compare how all Medicare Part D PDP plans in LA cover ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
ESOMEPRAZOLE SODIUM 20 MG VIAL [Nexium] ![Compare how all Medicare Part D PDP plans in LA cover ESOMEPRAZOLE SODIUM 20 MG VIAL [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
ESOMEPRAZOLE SODIUM 40 MG VIAL [Nexium] ![Compare how all Medicare Part D PDP plans in LA cover ESOMEPRAZOLE SODIUM 40 MG VIAL [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
ESTARYLLA 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in LA cover ESTARYLLA 0.25-0.035 MG TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ESTRADIOL 0.01% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Estradiol 0.025 mg patch  |
2 |
Generic |
$10.00 | $30.00 | P Q:8 /28Days |
Estradiol 0.0375 mg patch  |
2 |
Generic |
$10.00 | $30.00 | P Q:8 /28Days |
Estradiol 0.05 mg patch  |
2 |
Generic |
$10.00 | $30.00 | P Q:8 /28Days |
Estradiol 0.075 mg patch  |
2 |
Generic |
$10.00 | $30.00 | P Q:8 /28Days |
Estradiol 0.1 mg patch  |
2 |
Generic |
$10.00 | $30.00 | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 0.5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | P |
ESTRADIOL 1 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | P |
ESTRADIOL 10 MCG VAGINAL INSRT  |
4 |
Non-Preferred Drug |
50% | 50% | Q:18 /28Days |
ESTRADIOL 2MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | P |
ESTRADIOL TDS 0.025 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.0375 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.05 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.06 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.075 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.1 MG/DAY  |
2 |
Generic |
$10.00 | $30.00 | P Q:4 /28Days |
ESTRADIOL VALERATE 20mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL VALERATE 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
ESTRING 2MG VAGINAL RING  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:1 /90Days |
ETHACRYNATE SODIUM 50 MG VIAL [Edecrin] ![Compare how all Medicare Part D PDP plans in LA cover ETHACRYNATE SODIUM 50 MG VIAL [Edecrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
ETHAMBUTOL HCL 400 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
Ethambutol Hydrochloride 100mg/1  |
2 |
Generic |
$10.00 | $30.00 | None |
Ethinyl Estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv] ![Compare how all Medicare Part D PDP plans in LA cover Ethinyl Estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6  |
2 |
Generic |
$10.00 | $30.00 | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21  |
2 |
Generic |
$10.00 | $30.00 | None |
ETHOSUXIMIDE 250 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
ETHOSUXIMIDE 250 MG/5 ML SOLN  |
2 |
Generic |
$10.00 | $30.00 | None |
ethynodiol-eth estra 1mg-50mcg [ZOVIA] ![Compare how all Medicare Part D PDP plans in LA cover ethynodiol-eth estra 1mg-50mcg [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETIDRONATE DISODIUM 400MG TABLET (60 CT)  |
2 |
Generic |
$10.00 | $30.00 | None |
ETIDRONATE DISODIUM TABLETS 200MG 60 BOT  |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC 200 MG CAPSULE [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC 200 MG CAPSULE [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC 300 MG CAPSULE [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC 300 MG CAPSULE [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC 400 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC 400 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC 500 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC 500 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC ER 400 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC ER 400 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC ER 500 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC ER 500 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
ETODOLAC ER 600 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in LA cover ETODOLAC ER 600 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
EVOTAZ 300 MG-150 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
EXEMESTANE 25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXJADE 125MG TABLET  |
5 |
Specialty Tier |
33% | N/A | S |
EXJADE 250MG TABLET  |
5 |
Specialty Tier |
33% | N/A | S |
EXJADE 500MG TABLET  |
5 |
Specialty Tier |
33% | N/A | S |
Ezetimibe 10 MG Oral Tablet [Zetia] ![Compare how all Medicare Part D PDP plans in LA cover Ezetimibe 10 MG Oral Tablet [Zetia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
Ezetimibe-Simvastatin 10-10 MG [Vytorin] ![Compare how all Medicare Part D PDP plans in LA cover Ezetimibe-Simvastatin 10-10 MG [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
Ezetimibe-Simvastatin 10-20 MG [Vytorin] ![Compare how all Medicare Part D PDP plans in LA cover Ezetimibe-Simvastatin 10-20 MG [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
Ezetimibe-Simvastatin 10-40 MG [Vytorin] ![Compare how all Medicare Part D PDP plans in LA cover Ezetimibe-Simvastatin 10-40 MG [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
Ezetimibe-Simvastatin 10-80 MG [Vytorin] ![Compare how all Medicare Part D PDP plans in LA cover Ezetimibe-Simvastatin 10-80 MG [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |