2018 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Select (PDP) (S5810-292-0)
Benefit Details
 |
The Aetna Medicare Rx Select (PDP) (S5810-292-0) Formulary Drugs Starting with the Letter T in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $17.70 Deductible: $405 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 |
37% | N/A | None |
TACLONEX OINTMENT  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:400 /28Days |
TACLONEX SCALP SUSPENSION  |
4 |
Non-Preferred Drug |
37% | N/A | S |
Tacrolimus 0.03% ointment  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
Tacrolimus 0.1% ointment  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
TACROLIMUS 0.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TACROLIMUS 1 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TACROLIMUS 5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TAFINLAR 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
TAFINLAR 75 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TAGRISSO 40 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TAGRISSO 80 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TAMIFLU 30 MG 1 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TAMIFLU 45 MG 1 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TAMIFLU 6 MG/ML SUSPENSION  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TAMIFLU 75 MG CAPSULE UD  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TAMOXIFEN 10 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TAMOXIFEN CITRATE 20MG TABLET (30 CT)  |
2* |
Generic |
$3.00 | N/A | None |
TAMSULOSIN HCL 0.4 MG CAPSULE  |
2* |
Generic |
$3.00 | N/A | Q:60 /30Days |
TAPAZOLE 10MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TAPAZOLE 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TARCEVA 100MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TARCEVA 150MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TARCEVA 25MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TARGRETIN 1% GEL  |
5 |
Specialty Tier |
25% | N/A | P |
Tarina Fe 1-20 tablet  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Tarka 2; 240mg/1; mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TARKA 2/180MG TABLET SA  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tarka 4; 240mg/1; mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tasigna 150mg/1 4 BLISTER PACK per CARTON / 28 CAPSULE per BLISTER PACK  |
5 |
Specialty Tier |
25% | N/A | P |
TASIGNA 200 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
TASIGNA 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TAXOTERE 80mg/4mL 1 VIAL, GLASS per CARTON / 4 mL in 1 VIAL, GLASS  |
5 |
Specialty Tier |
25% | N/A | P |
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 |
37% | N/A | None |
TAZICEF 1GM VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TAZICEF 2 GRAM VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TAZICEF 6 GRAM VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TAZORAC 0.05% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TAZORAC 0.05% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TAZORAC 0.1% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TAZORAC 0.1% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TAZTIA DILTIAZEM HYDROCHLORIDE 120MG ER CAPSULES  |
2* |
Generic |
$3.00 | N/A | None |
TAZTIA XT 180 MG CAPSULE  |
2* |
Generic |
$3.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TAZTIA XT 240MG CAPSULE SA  |
2* |
Generic |
$3.00 | N/A | None |
TAZTIA XT 300 MG CAPSULE  |
2* |
Generic |
$3.00 | N/A | None |
TAZTIA XT 360MG CAPSULE SA  |
2* |
Generic |
$3.00 | N/A | None |
TECENTRIQ 1,200 MG/20 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
Teflaro 400mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE  |
5 |
Specialty Tier |
25% | N/A | None |
Teflaro 600mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE  |
5 |
Specialty Tier |
25% | N/A | None |
TEGRETOL SUSPENSION 100MG/5ML 450 ML BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TEGRETOL TABLETS 200MG 100 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TEGRETOL XR TABLETS 100MG 100 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TEGRETOL XR TABLETS 200MG 100 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TEGRETOL XR TABLETS 400MG 100 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TEKTURNA 150 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TEKTURNA 300 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TEKTURNA HCT 300-25 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | 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) |
2* |
Generic |
$3.00 | N/A | 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) |
2* |
Generic |
$3.00 | N/A | 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) |
2* |
Generic |
$3.00 | N/A | Q:30 /30Days |
Telmisartan-Amlodipine 40-10 MG [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan-Amlodipine 40-10 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
Telmisartan-Amlodipine 40-5 MG [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan-Amlodipine 40-5 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
Telmisartan-Amlodipine 80-10 MG [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan-Amlodipine 80-10 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
Telmisartan-Amlodipine 80-5 MG [Micardis] ![Compare how all Medicare Part D PDP plans in LA cover Telmisartan-Amlodipine 80-5 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | 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 |
$46.00 | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$46.00 | N/A | Q:30 /30Days |
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 |
$46.00 | N/A | Q:30 /30Days |
TEMAZEPAM 15 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TEMAZEPAM 22.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TEMAZEPAM 30 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
Temazepam 7.5mg/1 100 CAPSULE BOTTLE, PLASTIC  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TENIVAC SYRINGE  |
3 |
Preferred Brand |
$46.00 | N/A | P |
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 |
25% | N/A | None |
TENORMIN 100 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TENORMIN 25 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TENORMIN 50 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TERAZOSIN 1 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | 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) |
1* |
Preferred Generic |
$0.00 | N/A | None |
TERAZOSIN 2 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | 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) |
1* |
Preferred Generic |
$0.00 | N/A | None |
TERBINAFINE HCL 250 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TERBUTALINE SULF 1MG/ML VL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TERBUTALINE SULFATE 2.5 MG TAB  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TERBUTALINE SULFATE 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TERCONAZOLE 0.4% CREAM WITH APPLICATOR  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TERCONAZOLE 0.8% CREAM  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TERCONAZOLE 80MG SUPPOSITORY VAGINAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TESTIM 1%(50MG) GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:300 /30Days |
TESTOSTERONE 10 MG GEL PUMP  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:120 /30Days |
TESTOSTERONE 12.5 MG/1.25 GRAM  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:300 /30Days |
Testosterone 2500 MG 0.01 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:300 /30Days |
TESTOSTERONE 30 MG/1.5 ML PUMP  |
3 |
Preferred Brand |
$46.00 | N/A | P Q:440 /30Days |
Testosterone 5000 MG 0.01 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:300 /30Days |
Testosterone cyp 100 mg/ml  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TESTOSTERONE CYP 200 MG/ML  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Testosterone cypionate 200 MG/ML Injectable Solution [Depo-testosterone] ![Compare how all Medicare Part D PDP plans in LA cover Testosterone cypionate 200 MG/ML Injectable Solution [Depo-testosterone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | P |
TESTOSTERONE ENANTHATE 200MG/ML INJECTION  |
4 |
Non-Preferred Drug |
37% | N/A | 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 |
25% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
25% | N/A | P Q:120 /30Days |
TETRACYCLINE 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TETRACYCLINE 500 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THALOMID 100 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
THALOMID 150 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
THALOMID 200 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
THALOMID 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
THEO-24 ER 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THEO-24 ER 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THEO-24 ER 300 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THEO-24 ER 400 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
THEOPHYLLINE 80 MG/15 ML SOLN  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THEOPHYLLINE ER 100 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THEOPHYLLINE ER 200 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THEOPHYLLINE ER 300 MG TAB  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THEOPHYLLINE ER 400 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THEOPHYLLINE ER 600 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
THIORIDAZINE 10 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | P |
THIORIDAZINE 100MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | P |
THIORIDAZINE 25 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | P |
THIORIDAZINE 50 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | P |
THIOTEPA 15 MG VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
THIOTHIXENE 1 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THIOTHIXENE 10MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THIOTHIXENE 2MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THIOTHIXENE 5MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
THYMOGLOBULIN 25MG VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
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 |
37% | N/A | 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 |
37% | N/A | 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 |
37% | N/A | 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 |
37% | N/A | None |
TIAZAC ER 120 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIAZAC ER 180 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TIAZAC ER 240 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIAZAC ER 300 MG CAPSULE CAP SA 24H  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIAZAC ER 360 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIAZAC ER 420 MG CAPSULE CAP SA 24H  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIGAN 100 MG/ML VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TIGAN 300MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
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 |
25% | N/A | None |
TIKOSYN .125MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TIKOSYN .250MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TIKOSYN .5MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TIMOLOL 0.25% EYE DROPS  |
1* |
Preferred Generic |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TIMOLOL 0.25% GFS GEL-SOLUTION  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIMOLOL 0.5% EYE DROPS  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TIMOLOL 0.5% EYE DROPS  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TIMOLOL 0.5% GFS GEL-SOLUTION  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIMOLOL MALEATE 10MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TIMOLOL MALEATE 20MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TIMOLOL MALEATE 5MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TIMOPTIC 0.25% OCUDOSE DROP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIMOPTIC 0.5% OCUDOSE DROP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIMOPTIC-XE 0.25% EYE GEL-SOLN SOL-GEL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TINIDAZOLE 250 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TINIDAZOLE 500 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 100ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 112ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 125ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 137ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 13ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 150ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 25ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 50ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 75ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Tirosint 88ug/1 4 BLISTER PACK per CARTON / 7 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TIVICAY 10 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TIVICAY 25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
TIVICAY 50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
TIVORBEX 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TIVORBEX 40 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TIZANIDINE HCL 2 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIZANIDINE HCL 2 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TIZANIDINE HCL 4 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TIZANIDINE HCL 4 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TIZANIDINE HCL 6 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOBI 300mg/5mL 56 AMPULE per CARTON / 5 mL in 1 AMPULE  |
5 |
Specialty Tier |
25% | N/A | P Q:280 /56Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOBI PODHALER 28 MG INHALE CAP  |
5 |
Specialty Tier |
25% | N/A | P Q:224 /42Days |
TOBRADEX EYE OINTMENT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOBRADEX ST 0.5; 3mg/mL; mg/mL 5 mL in 1 BOTTLE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOBRADEX SUSPENSION OPHTHALMIC 0.1%/0.3% 5ML BOT  |
4 |
Non-Preferred Drug |
37% | N/A | 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 |
$3.00 | N/A | 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 |
37% | N/A | 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) |
3 |
Preferred Brand |
$46.00 | N/A | P Q:280 /56Days |
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 |
37% | N/A | None |
TOBRAMYCIN-DEXAMETH OPTH SUSP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOBREX 0.3% EYE DROPS  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOBREX 0.3% EYE OINTMENT  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOFRANIL 50MG TABLET (30 CT)  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TOFRANIL TABLETS 10MG 30 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TOFRANIL TABLETS 25MG 30 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TOLAK 4% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOLAZAMIDE TABLETS 250MG 100 BOT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOLAZAMIDE TABLETS 500MG 100 BOT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOLBUTAMIDE 500 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TOLTERODINE TARTRATE 1 MG TAB [Detrol LA] ![Compare how all Medicare Part D PDP plans in LA cover TOLTERODINE TARTRATE 1 MG TAB [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
TOLTERODINE TARTRATE 2 MG TAB [Detrol LA] ![Compare how all Medicare Part D PDP plans in LA cover TOLTERODINE TARTRATE 2 MG TAB [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
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 |
37% | N/A | Q:30 /30Days |
TOPAMAX 15 MG SPRINKLE CAP  |
4 |
Non-Preferred Drug |
37% | N/A | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOPAMAX 25 MG SPRINKLE CAP  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPAMAX TABLETS 100MG 60 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPAMAX TABLETS 200MG 60 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPAMAX TABLETS 25MG 60 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPAMAX TABLETS 50MG 60 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPICORT 0.25% SPRAY  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Topicort 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Topicort 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Topicort 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Topicort 2.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Topicort 2.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOPIRAMATE 100 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TOPIRAMATE 15 MG SPRINKLE CAP  |
2* |
Generic |
$3.00 | N/A | None |
TOPIRAMATE 200 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TOPIRAMATE 25 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
Topiramate 25mg/1  |
2* |
Generic |
$3.00 | N/A | None |
TOPIRAMATE 50 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TOPIRAMATE ER 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOPIRAMATE ER 150 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOPIRAMATE ER 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOPIRAMATE ER 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TOPIRAMATE ER 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | 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  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Topotecan 4 MG Injection  |
5 |
Specialty Tier |
25% | N/A | None |
TOPROL XL 100 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPROL XL 200 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPROL XL 25 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TOPROL XL 50 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | S |
Torisel 1 KIT per CARTON  |
5 |
Specialty Tier |
25% | N/A | None |
TORSEMIDE 10 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TORSEMIDE 100 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TORSEMIDE 20 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TORSEMIDE 5 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TOUJEO MAX SOLOSTAR 300UNIT/ML INSULN PEN  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOUJEO SOLOSTAR 300 UNITS/ML  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TOVIAZ TABLETS 4MG EXTENDED RELEASE  |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
TOVIAZ TABLETS 8MG EXTENDED RELEASE  |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
TPN ELECTROLYTES16.5/25.4 VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRACLEER 125MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
TRACLEER 32 MG TABLET FOR SUSP  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
TRACLEER 62.5MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
TRADJENTA 5 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
TRAMADOL ER 100 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL ER 200 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRAMADOL ER 300 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL ER 300 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL HCL 50 MG TABLET  |
2* |
Generic |
$3.00 | N/A | Q:240 /30Days |
TRAMADOL HCL ER 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL HCL ER 100 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL HCL ER 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL HCL ER 200 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL HCL ER 300 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRAMADOL-ACETAMINOPHN 37.5-325  |
4 |
Non-Preferred Drug |
37% | N/A | Q:240 /30Days |
TRANDOLAPRIL 1 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANDOLAPRIL 2 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRANDOLAPRIL 4 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANDOLAPRIL-VERAPAMIL ER 1-240 MG  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANDOLAPRIL-VERAPAMIL ER 2-180 MG  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANDOLAPRIL-VERAPAMIL ER 2-240 MG  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANDOLAPRIL-VERAPAMIL ER 4-240 MG  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRANEXAMIC ACID 1,000 MG/10 ML  |
4 |
Non-Preferred Drug |
37% | N/A | None |
tranexamic acid 650 mg tablet  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
TRANSDERM-SCOP 1.5 MG/3 DAY  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:10 /30Days |
TRANXENE T-TAB 7.5 MG  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRANYLCYPROMINE SULFATE 10MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRAVASOL 10% SOLUTION VIAFLEX  |
4 |
Non-Preferred Drug |
37% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRAVATAN Z 0.04MG DROPS 2.5ML BOT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRAZODONE 100 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TRAZODONE 300 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TRAZODONE 50 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
TRAZODONE HCL TABLET USP 150MG (100 CT)  |
2* |
Generic |
$3.00 | N/A | None |
TREANDA 25 MG VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
TREANDA FOR INJECTION 100MG/VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
TRECATOR 250MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRELSTAR 11.25 MG SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P |
TRELSTAR 3.75 MG SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P |
TRESIBA FLEXTOUCH 100 UNITS/ML  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRESIBA FLEXTOUCH 200 UNITS/ML  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Tretinoin 0.0004 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
37% | N/A | P |
Tretinoin 0.0005 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
37% | N/A | P |
Tretinoin 0.001 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 0.01% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 0.025% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 0.025% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 0.05% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 0.1% CREAM  |
4 |
Non-Preferred Drug |
37% | N/A | P |
Tretinoin 0.25 MG/ML Topical Cream [Retin-A] ![Compare how all Medicare Part D PDP plans in LA cover Tretinoin 0.25 MG/ML Topical Cream [Retin-A].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | P |
Tretinoin 0.5 MG/ML Topical Cream [Retin-A] ![Compare how all Medicare Part D PDP plans in LA cover Tretinoin 0.5 MG/ML Topical Cream [Retin-A].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Tretinoin 1 MG/ML Topical Cream [Retin-A] ![Compare how all Medicare Part D PDP plans in LA cover Tretinoin 1 MG/ML Topical Cream [Retin-A].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRETINOIN 10MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
TREXALL 10MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TREXALL 15MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TREXALL 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TREXALL 7.5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TREXIMET 85-500 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:9 /30Days |
TRI PREVIFEM TABLETS  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRI-LEGEST FE 5-7-9-7 TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | 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) |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRI-LO-SPRINTEC TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRI-SPRINTEC 7DAYSX3 28 TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | 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) |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRIAMCINOLONE 0.025% CREAM  |
2* |
Generic |
$3.00 | N/A | None |
TRIAMCINOLONE 0.025% LOTION  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRIAMCINOLONE 0.025% OINT  |
2* |
Generic |
$3.00 | N/A | None |
TRIAMCINOLONE 0.1% CREAM  |
2* |
Generic |
$3.00 | N/A | 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 |
$46.00 | N/A | None |
TRIAMCINOLONE 0.1% OINTMENT  |
2* |
Generic |
$3.00 | N/A | None |
TRIAMCINOLONE 0.1% PASTE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Triamcinolone 0.147 MG/G Spray  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
37% | N/A | None |
Triamcinolone 55 mcg nasal spr  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE  |
2* |
Generic |
$3.00 | N/A | 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) |
4 |
Non-Preferred Drug |
37% | N/A | None |
Triamcinolone Acetonide 5mg/g 1 TUBE per CARTON / 15 g in 1 TUBE  |
2* |
Generic |
$3.00 | N/A | None |
TRIAMTERENE-HCTZ 37.5-25 MG CP  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRIAMTERENE-HCTZ 37.5-25 MG TB  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRIAMTERENE-HCTZ 75-50 MG TAB  |
1* |
Preferred Generic |
$0.00 | N/A | None |
Trianex 0.05% Ointment  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIAZOLAM 0.125 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
TRIAZOLAM 0.25 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRIBENZOR 20/5/12.5MG TABLETS  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
TRIBENZOR 40/10/12.5MG TABLETS  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
TRIBENZOR 40/10/25MG TABLETS  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
Tribenzor 5; 12.5; 40mg/1; mg/1; mg/1  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
Tribenzor 5; 25; 40mg/1; mg/1; mg/1  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
TRICOR 145 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRICOR 48 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | 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 |
25% | N/A | None |
TRIFLUOPERAZINE 1MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIFLUOPERAZINE HCL 2MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIFLUOPERAZINE HCL 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML BOT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRIGLIDE 160 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRIHEXYPHENIDYL 2 MG TABLET  |
2* |
Generic |
$3.00 | N/A | P |
TRIHEXYPHENIDYL 5 MG TABLET  |
2* |
Generic |
$3.00 | N/A | P |
Trihexyphenidyl Hydrochloride 2mg/5mL 473 mL in 1 BOTTLE  |
2* |
Generic |
$3.00 | N/A | P |
TRILEPTAL 150MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TRILEPTAL 300MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TRILEPTAL 300MG/5ML SUSP  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TRILEPTAL 600MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S |
TRILIPIX DR 135 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRILIPIX DR 45 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRILYTE WITH FLAVOR PACKETS  |
2* |
Generic |
$3.00 | N/A | None |
TRIMETHOBENZAMIDE 300 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRIMETHOPRIM 100 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
TRIMIPRAMINE MALEATE 100 MG CP  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRIMIPRAMINE MALEATE 25 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRIMIPRAMINE MALEATE 50 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TRINESSA TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRINTELLIX 10 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:60 /30Days |
TRINTELLIX 20 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
TRINTELLIX 5 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Triostat 10ug/mL 6 VIAL in 1 CARTON / 1 mL in 1 VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
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 |
25% | N/A | P |
TRISENOX 12 MG/6 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
TRIUMEQ TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
Trivora-28 tablet  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TROKENDI XR 100 MG CAPSULE ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TROKENDI XR 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TROKENDI XR 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TROKENDI XR 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TROPHAMINE INJECTION SOLUTION  |
4 |
Non-Preferred Drug |
37% | N/A | P |
TROSPIUM CHLORIDE 20 MG TABLET  |
2* |
Generic |
$3.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TROSPIUM CHLORIDE ER 60 MG CAP  |
2* |
Generic |
$3.00 | N/A | Q:30 /30Days |
TRULICITY 0.75 MG/0.5 ML PEN  |
4 |
Non-Preferred Drug |
37% | N/A | Q:4 /28Days |
TRULICITY 1.5 MG/0.5 ML PEN  |
4 |
Non-Preferred Drug |
37% | N/A | Q:4 /28Days |
TRUMENBA 120 MCG/0.5 ML VACCIN Syringe  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TRUSOPT PLUS 2% EYE DROPS 10ML BOT  |
4 |
Non-Preferred Drug |
37% | N/A | None |
TRUVADA 100 MG-150 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
TRUVADA 133 MG-200 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
TRUVADA 167 MG-250 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
TRUVADA 200/300MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
TWINRIX VACCINE SYRINGE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Twynsta 10; 40mg/1; mg/1 3 BLISTER PACK per CARTON / 10 TABLET, MULTILAYER per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Twynsta 10; 80mg/1; mg/1 3 BLISTER PACK per CARTON / 10 TABLET, MULTILAYER per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
Twynsta 5; 40mg/1; mg/1 3 BLISTER PACK per CARTON / 10 TABLET, MULTILAYER per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
Twynsta 5; 80mg/1; mg/1 3 BLISTER PACK per CARTON / 10 TABLET, MULTILAYER per BLISTER PACK  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
TYBOST 150 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TYDEMY TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Tygacil 50mg/5mL 10 VIAL, SINGLE-USE per CARTON / 50 mL in 1 VIAL, SINGLE-USE  |
5 |
Specialty Tier |
25% | N/A | None |
TYKERB 250 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
TYLENOL WITH CODEINE #3 TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:180 /30Days |
TYPHIM VI 25 MCG/0.5 ML SYRINGE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TYPHIM VI 25MCG/0.5ML VIAL  |
3 |
Preferred Brand |
$46.00 | N/A | None |
TYSABRI 300 MG/15 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |