2018 Medicare Part D Plan Formulary Information |
AARP MedicareRx Preferred (PDP) (S5820-020-0)
Benefit Details
 |
The AARP MedicareRx Preferred (PDP) (S5820-020-0) Formulary Drugs Starting with the Letter T in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $90.00 Deductible: $0 Qualifies for LIS: No |
Drugs Starting with Letter T
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
TABLOID 40 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | P |
Tacrolimus 0.03% ointment  |
4 |
Non-Preferred Drug |
40% | 40% | S |
Tacrolimus 0.1% ointment  |
4 |
Non-Preferred Drug |
40% | 40% | S |
TACROLIMUS 0.5 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | P |
TACROLIMUS 1 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | P |
TACROLIMUS 5 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | P |
TAFINLAR 50 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P |
TAFINLAR 75 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P |
TAGRISSO 40 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
TAGRISSO 80 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TAMIFLU 6 MG/ML SUSPENSION  |
4 |
Non-Preferred Drug |
40% | 40% | Q:780 /30Days |
TAMOXIFEN 10 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TAMOXIFEN CITRATE 20MG TABLET (30 CT)  |
2 |
Generic |
$8.00 | $0.00 | None |
TAMSULOSIN HCL 0.4 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | None |
TARCEVA 100MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
TARCEVA 150MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
TARCEVA 25MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:90 /30Days |
TARGRETIN 1% GEL  |
5 |
Specialty Tier |
33% | 33% | P |
Tarina Fe 1-20 tablet  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Tasigna 150mg/1 4 BLISTER PACK per CARTON / 28 CAPSULE per BLISTER PACK  |
5 |
Specialty Tier |
33% | 33% | P Q:150 /30Days |
TASIGNA 200 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TASIGNA 50 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:420 /30Days |
TAZAROTENE 0.1% CREAM [Tazorac] ![Compare how all Medicare Part D PDP plans in LA cover TAZAROTENE 0.1% CREAM [Tazorac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
TAZICEF 1GM VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TAZICEF 2 GRAM VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TAZICEF 6 GRAM VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TAZORAC 0.05% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TAZTIA DILTIAZEM HYDROCHLORIDE 120MG ER CAPSULES  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TAZTIA XT 180 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TAZTIA XT 240MG CAPSULE SA  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TAZTIA XT 300 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TAZTIA XT 360MG CAPSULE SA  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TECENTRIQ 1,200 MG/20 ML VIAL  |
5 |
Specialty Tier |
33% | 33% | P |
TECFIDERA DR 120 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TECFIDERA DR 240 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TECFIDERA STARTER PACK  |
5 |
Specialty Tier |
33% | 33% | None |
TEKTURNA 150 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
TEKTURNA 300 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
Telmisartan 20 MG Tablet [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan 20 MG Tablet [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
Telmisartan 40 MG Tablet [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan 40 MG Tablet [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
Telmisartan 80 MG Tablet [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan 80 MG Tablet [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TELMISARTAN-HCTZ 40-12.5 MG TB [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover TELMISARTAN-HCTZ 40-12.5 MG TB [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TELMISARTAN-HCTZ 80-12.5 MG TAB [Micardis HCT] ![Compare how all Medicare Part D PDP plans in LA cover TELMISARTAN-HCTZ 80-12.5 MG TAB [Micardis HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TELMISARTAN-HCTZ 80-25 MG TAB [Micardis HCT] ![Compare how all Medicare Part D PDP plans in LA cover TELMISARTAN-HCTZ 80-25 MG TAB [Micardis HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TEMAZEPAM 15 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
TEMAZEPAM 30 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
TENIVAC SYRINGE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TENOFOVIR DISOP FUM 300 MG TB [Viread] ![Compare how all Medicare Part D PDP plans in LA cover TENOFOVIR DISOP FUM 300 MG TB [Viread].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TERAZOSIN 1 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | None |
TERAZOSIN 10 MG CAPSULE [Hytrin] ![Compare how all Medicare Part D PDP plans in LA cover TERAZOSIN 10 MG CAPSULE [Hytrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
TERAZOSIN 2 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | None |
TERAZOSIN 5 MG CAPSULE [Hytrin] ![Compare how all Medicare Part D PDP plans in LA cover TERAZOSIN 5 MG CAPSULE [Hytrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
TERBINAFINE HCL 250 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TERCONAZOLE 0.4% CREAM WITH APPLICATOR  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TERCONAZOLE 0.8% CREAM  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TERCONAZOLE 80MG SUPPOSITORY VAGINAL  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Testosterone cyp 100 mg/ml  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TESTOSTERONE CYP 200 MG/ML  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TESTOSTERONE ENANTHATE 200MG/ML INJECTION  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TETRABENAZINE 12.5 MG TABLET [XENAZINE] ![Compare how all Medicare Part D PDP plans in LA cover TETRABENAZINE 12.5 MG TABLET [XENAZINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:90 /30Days |
TETRABENAZINE 25 MG TABLET [XENAZINE] ![Compare how all Medicare Part D PDP plans in LA cover TETRABENAZINE 25 MG TABLET [XENAZINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
TETRACYCLINE 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TETRACYCLINE 500 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
THALOMID 100 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
THALOMID 150 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
THALOMID 200 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
THALOMID 50 MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
THEOPHYLLINE 80 MG/15 ML SOLN  |
2 |
Generic |
$8.00 | $0.00 | None |
THEOPHYLLINE ER 100 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
THEOPHYLLINE ER 200 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
THEOPHYLLINE ER 300 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
THEOPHYLLINE ER 400 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
THEOPHYLLINE ER 600 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
THIORIDAZINE 10 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIORIDAZINE 100MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIORIDAZINE 25 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
THIORIDAZINE 50 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIOTEPA 15 MG VIAL  |
5 |
Specialty Tier |
33% | 33% | None |
THIOTHIXENE 1 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIOTHIXENE 10MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIOTHIXENE 2MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THIOTHIXENE 5MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
THYMOGLOBULIN 25MG VIAL  |
5 |
Specialty Tier |
33% | 33% | None |
TIAGABINE HCL 12 MG TABLET [Gabitril] ![Compare how all Medicare Part D PDP plans in LA cover TIAGABINE HCL 12 MG TABLET [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TIAGABINE HCL 16 MG TABLET [Gabitril] ![Compare how all Medicare Part D PDP plans in LA cover TIAGABINE HCL 16 MG TABLET [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
tiagabine hcl 2 mg tablet [Gabitril] ![Compare how all Medicare Part D PDP plans in LA cover tiagabine hcl 2 mg tablet [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
tiagabine hcl 4 mg tablet [Gabitril] ![Compare how all Medicare Part D PDP plans in LA cover tiagabine hcl 4 mg tablet [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TIGECYCLINE 50 MG VIAL [Tygacil] ![Compare how all Medicare Part D PDP plans in LA cover TIGECYCLINE 50 MG VIAL [Tygacil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
TIMOLOL 0.25% EYE DROPS  |
2 |
Generic |
$8.00 | $0.00 | None |
TIMOLOL 0.25% GFS GEL-SOLUTION  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TIMOLOL 0.5% EYE DROPS  |
2 |
Generic |
$8.00 | $0.00 | None |
TIMOLOL 0.5% GFS GEL-SOLUTION  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TIMOLOL MALEATE 10MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TIMOLOL MALEATE 20MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TIMOLOL MALEATE 5MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TINIDAZOLE 250 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TINIDAZOLE 500 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TIVICAY 10 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TIVICAY 25 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TIVICAY 50 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days |
TIZANIDINE HCL 2 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TIZANIDINE HCL 4 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TOBI PODHALER 28 MG INHALE CAP  |
5 |
Specialty Tier |
33% | 33% | P Q:240 /30Days |
TOBRADEX EYE OINTMENT  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TOBRADEX ST 0.5; 3mg/mL; mg/mL 5 mL in 1 BOTTLE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TOBRAMYCIN 0.3% EYE DROPS [Tobrex] ![Compare how all Medicare Part D PDP plans in LA cover TOBRAMYCIN 0.3% EYE DROPS [Tobrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
TOBRAMYCIN 10 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in LA cover TOBRAMYCIN 10 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TOBRAMYCIN 300 MG/5 ML AMPULE [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in LA cover TOBRAMYCIN 300 MG/5 ML AMPULE [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:300 /30Days |
TOBRAMYCIN 40 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in LA cover TOBRAMYCIN 40 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOBRAMYCIN-DEXAMETH OPTH SUSP  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TOBREX 0.3% EYE OINTMENT  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Tolterodine Tartrate ER 2 MG CAPSULE [Detrol LA] ![Compare how all Medicare Part D PDP plans in LA cover Tolterodine Tartrate ER 2 MG CAPSULE [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TOLVAPTAN 15 MG ORAL TABLET [SAMSCA] ![Compare how all Medicare Part D PDP plans in LA cover TOLVAPTAN 15 MG ORAL TABLET [SAMSCA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
TOLVAPTAN 30 MG ORAL TABLET [SAMSCA] ![Compare how all Medicare Part D PDP plans in LA cover TOLVAPTAN 30 MG ORAL TABLET [SAMSCA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
TOPIRAMATE 100 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TOPIRAMATE 15 MG SPRINKLE CAP  |
2 |
Generic |
$8.00 | $0.00 | None |
TOPIRAMATE 200 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TOPIRAMATE 25 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Topiramate 25mg/1  |
2 |
Generic |
$8.00 | $0.00 | None |
TOPIRAMATE 50 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOPOSAR INJECTION 20MG/ML 50ML VIAL MD CRTN  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Topotecan 4 MG Injection  |
5 |
Specialty Tier |
33% | 33% | None |
Torisel 1 KIT per CARTON  |
5 |
Specialty Tier |
33% | 33% | None |
TORSEMIDE 10 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TORSEMIDE 100 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TORSEMIDE 20 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TORSEMIDE 5 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TOUJEO MAX SOLOSTAR 300UNIT/ML INSULN PEN  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TOUJEO SOLOSTAR 300 UNITS/ML  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TPN ELECTROLYTES16.5/25.4 VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRACLEER 125MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRACLEER 32 MG TABLET FOR SUSP  |
5 |
Specialty Tier |
33% | 33% | P Q:112 /28Days |
TRACLEER 62.5MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
TRADJENTA 5 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
TRAMADOL ER 100 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL ER 200 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL ER 300 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL ER 300 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL HCL 50 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:240 /30Days |
TRAMADOL HCL ER 100 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL HCL ER 200 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:30 /30Days |
TRAMADOL-ACETAMINOPHN 37.5-325  |
2 |
Generic |
$8.00 | $0.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRANDOLAPRIL 1 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
TRANDOLAPRIL 2 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
TRANDOLAPRIL 4 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
TRANEXAMIC ACID 1,000 MG/10 ML  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
tranexamic acid 650 mg tablet  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRANSDERM-SCOP 1.5 MG/3 DAY  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRANYLCYPROMINE SULFATE 10MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRAVASOL 10% SOLUTION VIAFLEX  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRAVATAN Z 0.04MG DROPS 2.5ML BOT  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRAZODONE 100 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TRAZODONE 300 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRAZODONE 50 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TRAZODONE HCL TABLET USP 150MG (100 CT)  |
2 |
Generic |
$8.00 | $0.00 | None |
TREANDA 25 MG VIAL  |
5 |
Specialty Tier |
33% | 33% | P |
TREANDA FOR INJECTION 100MG/VIAL  |
5 |
Specialty Tier |
33% | 33% | P |
TRECATOR 250MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRELEGY ELLIPTA 100-62.5-25  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
TRELSTAR 11.25 MG SYRINGE  |
5 |
Specialty Tier |
33% | 33% | P |
TRELSTAR 3.75 MG SYRINGE  |
5 |
Specialty Tier |
33% | 33% | P |
TRESIBA FLEXTOUCH 100 UNITS/ML  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRESIBA FLEXTOUCH 200 UNITS/ML  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Tretinoin 0.0004 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
40% | 40% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Tretinoin 0.001 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 0.01% GEL  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 0.025% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 0.025% GEL  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 0.05% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 0.1% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRETINOIN 10MG CAPSULE  |
5 |
Specialty Tier |
33% | 33% | None |
TREXALL 10MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TREXALL 15MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TREXALL 5MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TREXALL 7.5MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TREZIX 16-320.5-30 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | Q:300 /30Days |
TRI PREVIFEM TABLETS  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-LEGEST FE 5-7-9-7 TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-LO-ESTARYLLA TABLET [Trinessa Lo] ![Compare how all Medicare Part D PDP plans in LA cover TRI-LO-ESTARYLLA TABLET [Trinessa Lo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-LO-SPRINTEC TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-MILI 28 TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in LA cover TRI-MILI 28 TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-SPRINTEC 7DAYSX3 28 TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRI-VYLIBRA 28 TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in LA cover TRI-VYLIBRA 28 TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRIAMCINOLONE 0.025% CREAM  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIAMCINOLONE 0.025% LOTION  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIAMCINOLONE 0.025% OINT  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRIAMCINOLONE 0.1% CREAM  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIAMCINOLONE 0.1% LOTION [Kenalog] ![Compare how all Medicare Part D PDP plans in LA cover TRIAMCINOLONE 0.1% LOTION [Kenalog].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIAMCINOLONE 0.1% OINTMENT  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIAMCINOLONE 0.1% PASTE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIAMCINOLONE 200 MG/5 ML VIAL [Triesence] ![Compare how all Medicare Part D PDP plans in LA cover TRIAMCINOLONE 200 MG/5 ML VIAL [Triesence].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Triamcinolone 55 mcg nasal spr  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE  |
2 |
Generic |
$8.00 | $0.00 | None |
Triamcinolone Acetonide 1 MG/ML Topical Cream [Triderm] ![Compare how all Medicare Part D PDP plans in LA cover Triamcinolone Acetonide 1 MG/ML Topical Cream [Triderm].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
Triamcinolone Acetonide 5mg/g 1 TUBE per CARTON / 15 g in 1 TUBE  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIAMTERENE-HCTZ 37.5-25 MG CP  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIAMTERENE-HCTZ 37.5-25 MG TB  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRIAMTERENE-HCTZ 75-50 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIENTINE HCL 250 MG CAPSULE [Syprine] ![Compare how all Medicare Part D PDP plans in LA cover TRIENTINE HCL 250 MG CAPSULE [Syprine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:240 /30Days |
TRIFLUOPERAZINE 1MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIFLUOPERAZINE HCL 2MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIFLUOPERAZINE HCL 5MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML BOT  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRIHEXYPHENIDYL 2 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIHEXYPHENIDYL 5 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Trihexyphenidyl Hydrochloride 2mg/5mL 473 mL in 1 BOTTLE  |
2 |
Generic |
$8.00 | $0.00 | None |
TRILYTE WITH FLAVOR PACKETS  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRIMETHOPRIM 100 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
TRIMIPRAMINE MALEATE 100 MG CP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRIMIPRAMINE MALEATE 25 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRIMIPRAMINE MALEATE 50 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRINESSA TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TRINTELLIX 10 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
TRINTELLIX 20 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
TRINTELLIX 5 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
Triptorelin 11.3 MG/ML Injectable Suspension [Trelstar] ![Compare how all Medicare Part D PDP plans in LA cover Triptorelin 11.3 MG/ML Injectable Suspension [Trelstar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
TRISENOX 12 MG/6 ML VIAL  |
5 |
Specialty Tier |
33% | 33% | None |
TRIUMEQ TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Trivora-28 tablet  |
4 |
Non-Preferred Drug |
40% | 40% | None |
TROPHAMINE INJECTION SOLUTION  |
4 |
Non-Preferred Drug |
40% | 40% | P |
TRULICITY 0.75 MG/0.5 ML PEN  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:2 /28Days |
TRULICITY 1.5 MG/0.5 ML PEN  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:2 /28Days |
TRUMENBA 120 MCG/0.5 ML VACCIN Syringe  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TRUVADA 100 MG-150 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TRUVADA 133 MG-200 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TRUVADA 167 MG-250 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TRUVADA 200/300MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
TWINRIX VACCINE SYRINGE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TYBOST 150 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Tygacil 50mg/5mL 10 VIAL, SINGLE-USE per CARTON / 50 mL in 1 VIAL, SINGLE-USE  |
5 |
Specialty Tier |
33% | 33% | None |
TYKERB 250 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | P |
TYMLOS 80 MCG DOSE PEN INJECTR  |
5 |
Specialty Tier |
33% | 33% | P Q:2 /30Days |
TYPHIM VI 25 MCG/0.5 ML SYRINGE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TYPHIM VI 25MCG/0.5ML VIAL  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
TYSABRI 300 MG/15 ML VIAL  |
5 |
Specialty Tier |
33% | 33% | P |