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 M in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $55.20 Deductible: $0 Qualifies for LIS: No |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML  |
4 |
Non-Preferred Drug |
50% | 50% | Q:2 /365Days |
Magnesium Cl/ K+ Cl/ Sodium Acetate/ Sodium Cl/ Sodium gluconate pH 7.4 Solution [Physiosol] ![Compare how all Medicare Part D PDP plans in LA cover Magnesium Cl/ K+ Cl/ Sodium Acetate/ Sodium Cl/ Sodium gluconate pH 7.4 Solution [Physiosol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
MAGNESIUM SULFATE 50% VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MAGNESIUM SULFATE INJECTION 5 GM/10ML  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MAKENA 250 MG/ML VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
MAKENA 275 MG/1.1 ML AUTO INJCT  |
5 |
Specialty Tier |
33% | N/A | P |
MALATHION 0.5% LOTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MAPROTILINE 25MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
MAPROTILINE 50MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
MAPROTILINE 75MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MARLISSA-28 TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MARPLAN 10MG TABLET (100 CT)  |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days |
MATULANE 50 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
MATZIM LA 180 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MATZIM LA 240 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MATZIM LA 300 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MATZIM LA 360 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MATZIM LA 420 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MECLIZINE 12.5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MECLIZINE 25 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MECLOFENAMATE 100MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLOFENAMATE 50MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MEDROL 2 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MEDROXYPROGESTERONE 10 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in LA cover MEDROXYPROGESTERONE 10 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MEDROXYPROGESTERONE 150 MG/ML Syringe [Depo-Provera] ![Compare how all Medicare Part D PDP plans in LA cover MEDROXYPROGESTERONE 150 MG/ML Syringe [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:1 /90Days |
MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera] ![Compare how all Medicare Part D PDP plans in LA cover MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /90Days |
MEDROXYPROGESTERONE 2.5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in LA cover MEDROXYPROGESTERONE 2.5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MEDROXYPROGESTERONE 5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in LA cover MEDROXYPROGESTERONE 5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
MEFLOQUINE HCL 250 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MEGESTROL 20 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
MEGESTROL 40 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
MEGESTROL ACET 40 MG/ML SUSP  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEKINIST 0.5 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
MEKINIST 2 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
MELODETTA 24 FE CHEWABLE TAB [Minastrin] ![Compare how all Medicare Part D PDP plans in LA cover MELODETTA 24 FE CHEWABLE TAB [Minastrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
MELOXICAM 15 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:30 /30Days |
MELOXICAM 7.5 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:30 /30Days |
MELPHALAN 5 MG/ML INJECTABLE SOLUTION  |
5 |
Specialty Tier |
33% | N/A | P |
MEMANTINE 5-10 MG TITRATION PK [Namenda Titration] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE 5-10 MG TITRATION PK [Namenda Titration].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:49 /28Days |
MEMANTINE HCL 10 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL 10 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL 2 MG/ML SOLUTION [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:300 /30Days |
MEMANTINE HCL 5 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL 5 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:90 /30Days |
MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:30 /30Days |
MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:30 /30Days |
MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda] ![Compare how all Medicare Part D PDP plans in LA cover MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:30 /30Days |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MENEST 0.3MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
MENEST 0.625MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
MENEST 1.25MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | P |
MENOSTAR 14 MCG/DAY PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:4 /28Days |
MENVEO A-C-Y-W-135-DIP VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MERCAPTOPURINE 50 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MEROPENEM 500MG/VIAL FOR INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEROPENEM IV 1 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MESALAMINE 4 GM/60 ML ENEMA  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MESNA 1 GRAM/10 ML VIAL  |
2 |
Generic |
$10.00 | $30.00 | P |
MESNEX 400MG TABLET  |
5 |
Specialty Tier |
33% | N/A | None |
Metadate er 20 mg tablet  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
METAPROTERENOL 10MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METAPROTERENOL 20MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC  |
2 |
Generic |
$10.00 | $30.00 | None |
METFORMIN HCL 1,000 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL 500 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:150 /30Days |
METFORMIN HCL 850 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METFORMIN HCL ER 1,000 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL ER 500 MG OSM-TB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METFORMIN HCL ER 500 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:120 /30Days |
METFORMIN HCL ER 750 MG TABLET  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
Metformin HCL ER tab 1000mg  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:60 /30Days |
Metformin HCL ER tab 500mg  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:120 /30Days |
METHADONE 10 MG/5 ML SOLUTION  |
2 |
Generic |
$10.00 | $30.00 | Q:450 /30Days |
METHADONE 5 MG/5 ML SOLUTION  |
2 |
Generic |
$10.00 | $30.00 | Q:600 /30Days |
METHADONE HCL 10 MG TABLET [Methadose] ![Compare how all Medicare Part D PDP plans in LA cover METHADONE HCL 10 MG TABLET [Methadose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:120 /30Days |
METHADONE HCL 200 MG/20 ML VIAL [Dolophine] ![Compare how all Medicare Part D PDP plans in LA cover METHADONE HCL 200 MG/20 ML VIAL [Dolophine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:150 /30Days |
METHADONE HCL 5 MG TABLET [Methadose] ![Compare how all Medicare Part D PDP plans in LA cover METHADONE HCL 5 MG TABLET [Methadose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methazolamide 25 MG Oral Tablet  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METHAZOLAMIDE 50 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Methenamine Hippurate 1g/1  |
2 |
Generic |
$10.00 | $30.00 | None |
METHIMAZOLE 10 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHIMAZOLE 5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHOCARBAMOL 500 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | P |
METHOCARBAMOL 750 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | P |
methotrexate 1 gm vial  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METHOTREXATE 2.5MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHOTREXATE 250 MG/10 ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METHOTREXATE 250 MG/10 ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHOTREXATE 50 MG/2 ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Methoxsalen 10 mg Capsule [8-MOP] ![Compare how all Medicare Part D PDP plans in LA cover Methoxsalen 10 mg Capsule [8-MOP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
METHSCOPOLAMINE BROMIDE 2.5MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHSCOPOLAMINE BROMIDE 5 MG TAB  |
2 |
Generic |
$10.00 | $30.00 | None |
METHYLPHENIDATE 10 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE 10 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
METHYLPHENIDATE 20 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE 20 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
METHYLPHENIDATE 5 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE 5 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
METHYLPHENIDATE ER 10 MG TABLET [Methylin] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 10 MG TABLET [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
METHYLPHENIDATE ER 18 MG TABLET ER 24 [Concerta] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 18 MG TABLET ER 24 [Concerta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:120 /30Days |
METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
METHYLPHENIDATE ER 27 MG TABLET ER 24 [Concerta] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 27 MG TABLET ER 24 [Concerta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE ER 36 MG TABLET ER 24 [Concerta] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 36 MG TABLET ER 24 [Concerta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
METHYLPHENIDATE ER 54 MG TABLET ER 24 [Concerta] ![Compare how all Medicare Part D PDP plans in LA cover METHYLPHENIDATE ER 54 MG TABLET ER 24 [Concerta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
methylprednisolone 125 mg vial  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METHYLPREDNISOLONE 16MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHYLPREDNISOLONE 32MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METHYLPREDNISOLONE 4 MG DOSEPK  |
2 |
Generic |
$10.00 | $30.00 | None |
METHYLPREDNISOLONE 4 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
methylprednisolone 40 mg vial  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Methylprednisolone 40 mg/ml vl  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METHYLPREDNISOLONE 8 MG ORAL TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
Methylprednisolone acetate 80 MG per 1 ML Injection  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Metipranolol 0.3% eye drops  |
2 |
Generic |
$10.00 | $30.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE  |
2 |
Generic |
$10.00 | $30.00 | None |
METOCLOPRAMIDE 5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METOCLOPRAMIDE 5 MG/5 ML SOLN  |
2 |
Generic |
$10.00 | $30.00 | None |
Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METOLAZONE 10MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
METOLAZONE 2.5MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
METOLAZONE 5MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
METOPROLOL SUCC ER 100 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METOPROLOL SUCC ER 200 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METOPROLOL SUCC ER 25 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL SUCC ER 50 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | Q:60 /30Days |
METOPROLOL TARTRATE 100 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOPROLOL TARTRATE 25 MG TAB  |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
Metoprolol Tartrate 5 ML 1 MG/ML Injection  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METOPROLOL TARTRATE INJ.USP 5MG/5ML CARPUJECT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT)  |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE 0.75% CREAM Cream (g) [Vitazol] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE 0.75% CREAM Cream (g) [Vitazol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE 0.75% LOTION [MetroLotion] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE 0.75% LOTION [MetroLotion].](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 |
METRONIDAZOLE 250 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE 250 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METRONIDAZOLE 500 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE 500 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $12.00 | None |
METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE TOPICAL 1% GEL [MetroGel] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE TOPICAL 1% GEL [MetroGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole] ![Compare how all Medicare Part D PDP plans in LA cover METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | None |
MEXILETINE 150MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MEXILETINE 200MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MEXILETINE 250MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MIACALCIN 400 UNIT/2 ML VIAL  |
5 |
Specialty Tier |
33% | N/A | None |
MIBELAS 24 FE CHEWABLE TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Microgestin 21 1-20 tablet  |
2 |
Generic |
$10.00 | $30.00 | None |
MICROGESTIN 21 1.5-30 TAB  |
2 |
Generic |
$10.00 | $30.00 | None |
Microgestin fe 1-20 tablet  |
2 |
Generic |
$10.00 | $30.00 | None |
MICROGESTIN FE 1.5-30 TAB  |
2 |
Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 10 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 2.5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MIDODRINE HCL 5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
Migergot suppository  |
5 |
Specialty Tier |
33% | N/A | Q:20 /28Days |
Miglitol 100 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in LA cover Miglitol 100 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
Miglitol 25 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in LA cover Miglitol 25 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
Miglitol 50 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in LA cover Miglitol 50 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIGLUSTAT 100 MG CAPSULE [Zavesca] ![Compare how all Medicare Part D PDP plans in LA cover MIGLUSTAT 100 MG CAPSULE [Zavesca].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:90 /30Days |
MILI 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in LA cover MILI 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 |
MINITRAN 0.1 MG/HR PATCH  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MINITRAN 0.2 MG/HR PATCH  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MINITRAN 0.4 MG/HR PATCH  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MINITRAN 0.6 MG/HR PATCH  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MINIVELLE 0.025 MG PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:8 /28Days |
MINIVELLE 0.0375 MG PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:8 /28Days |
MINIVELLE 0.05 MG PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:8 /28Days |
MINIVELLE 0.075 MG PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:8 /28Days |
MINIVELLE 0.1 MG PATCH  |
3 |
Preferred Brand |
$42.00 | $126.00 | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MINOCYCLINE 100 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOCYCLINE 50 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOCYCLINE 75 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOCYCLINE HCL 100 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOCYCLINE HCL 75 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOCYCLINE HYDROCHLORIDE TABLETS 50MG  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOXIDIL 10MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MINOXIDIL 2.5MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MIRTAZAPINE 15 MG ODT  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 15 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 30 MG ODT  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIRTAZAPINE 30 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
Mirtazapine 45 mg odt  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 45 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 7.5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
misoprostol 100 mcg tablet  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
misoprostol 200 mcg tablet  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MITIGARE 0.6 MG CAPSULE  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
MITOMYCIN 20 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MITOMYCIN 40 MG VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
MITOMYCIN 5 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MITOXANTRONE INJECTION 2MG 125ML VIAL  |
2 |
Generic |
$10.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOBIC 15MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
MOBIC 7.5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
MODAFINIL 100 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in LA cover MODAFINIL 100 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
MODAFINIL 200 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in LA cover MODAFINIL 200 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
Moexipril hcl 15 mg tablet  |
2 |
Generic |
$10.00 | $30.00 | None |
MOEXIPRIL HCL 7.5 MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET  |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MOMETASONE FUROATE 0.1% CREAM  |
2 |
Generic |
$10.00 | $30.00 | None |
MOMETASONE FUROATE 0.1% OINT  |
2 |
Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOMETASONE FUROATE 0.1% SOLN  |
2 |
Generic |
$10.00 | $30.00 | None |
MOMETASONE FUROATE 50 MCG SPRY  |
2 |
Generic |
$10.00 | $30.00 | Q:34 /30Days |
MONTELUKAST SOD 10 MG TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in LA cover MONTELUKAST SOD 10 MG TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MONTELUKAST SOD 4 MG GRANULES [Singulair] ![Compare how all Medicare Part D PDP plans in LA cover MONTELUKAST SOD 4 MG GRANULES [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MONTELUKAST SOD 4 MG TAB CHEW [Singulair] ![Compare how all Medicare Part D PDP plans in LA cover MONTELUKAST SOD 4 MG TAB CHEW [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MONTELUKAST SOD 5 MG TAB CHEW [Singulair] ![Compare how all Medicare Part D PDP plans in LA cover MONTELUKAST SOD 5 MG TAB CHEW [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
MORGIDOX 50 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MORPHINE 10 MG/ML ISECURE SYR  |
4 |
Non-Preferred Drug |
50% | 50% | Q:200 /30Days |
Morphine 2 mg/ml isecure syr  |
4 |
Non-Preferred Drug |
50% | 50% | Q:1260 /30Days |
Morphine 4 mg/ml isecure syr  |
4 |
Non-Preferred Drug |
50% | 50% | Q:630 /30Days |
MORPHINE 5 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE 8 MG/ML ISECURE SYR  |
4 |
Non-Preferred Drug |
50% | 50% | Q:250 /30Days |
MORPHINE SULF 20 MG/5 ML SOLN  |
2 |
Generic |
$10.00 | $30.00 | Q:300 /30Days |
MORPHINE SULF ER 100 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
MORPHINE SULF ER 15 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
MORPHINE SULF ER 200 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
MORPHINE SULF ER 30 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
MORPHINE SULF ER 60 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:90 /30Days |
MORPHINE SULFATE 100 mg/5 ml soln  |
2 |
Generic |
$10.00 | $30.00 | Q:180 /30Days |
MORPHINE SULFATE 10MG/5ML ORAL SOLUTION  |
2 |
Generic |
$10.00 | $30.00 | Q:700 /30Days |
MORPHINE SULFATE 15MG TABLETS  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:120 /30Days |
MORPHINE SULFATE 30MG TABLETS  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOVIPREP 7.5-2.691G POWDER IN PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MOXIFLOXACIN 0.5% EYE DROPS  |
3 |
Preferred Brand |
$42.00 | $126.00 | None |
MOXIFLOXACIN 400 MG/250 ML BAG PIGGYBACK [Avelox I.V.] ![Compare how all Medicare Part D PDP plans in LA cover MOXIFLOXACIN 400 MG/250 ML BAG PIGGYBACK [Avelox I.V.].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
MOXIFLOXACIN HCL 400 MG TABLET [Avelox] ![Compare how all Medicare Part D PDP plans in LA cover MOXIFLOXACIN HCL 400 MG TABLET [Avelox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
MOZOBIL 20 MG/ML VIAL  |
5 |
Specialty Tier |
33% | N/A | Q:10 /30Days |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days |
MUPIROCIN 2% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
MUPIROCIN 2% OINTMENT  |
2 |
Generic |
$10.00 | $30.00 | None |
MUSTARGEN 10 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MYCOPHENOLATE 200 MG/ML SUSP  |
5 |
Specialty Tier |
33% | N/A | P |
MYCOPHENOLATE 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MYCOPHENOLATE 500 MG TABLET [CellCept] ![Compare how all Medicare Part D PDP plans in LA cover MYCOPHENOLATE 500 MG TABLET [CellCept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
Mycophenolate 500 mg vial  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MYCOPHENOLIC ACID DR 180 MG TB  |
4 |
Non-Preferred Drug |
50% | 50% | P |
MYCOPHENOLIC ACID DR 360 MG TB  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Mylotarg 5 mg/5mL 5 mL in 1 VIAL, SINGLE-DOSE  |
5 |
Specialty Tier |
33% | N/A | P |
MYORISAN 10 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MYORISAN 20 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
Myorisan 30 mg capsule  |
2 |
Generic |
$10.00 | $30.00 | None |
MYORISAN 40 MG CAPSULE  |
2 |
Generic |
$10.00 | $30.00 | None |
MYRBETRIQ ER 25 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |
MYRBETRIQ ER 50 MG TABLET  |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days |