2019 Medicare Part D Plan Formulary Information |
SummaCare Medicare Sapphire (HMO-POS) (H3660-029-0)
Benefit Details
![Email Prescription and/or Health Benefit details for SummaCare Medicare Sapphire (HMO-POS). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The SummaCare Medicare Sapphire (HMO-POS) (H3660-029-0) Formulary Drugs Starting with the Letter L in Columbiana County, OH: CMS MA Region 12 which includes: OH Plan Monthly Premium: $76.00 Deductible: $0 |
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LABETALOL HCL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LABETALOL HCL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LABETALOL HCL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LABETALOL HCL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LACTULOSE 10 GM/15 ML SOLUTION [Constulose] ![Compare how all Medicare Part D PDP plans in OH cover LACTULOSE 10 GM/15 ML SOLUTION [Constulose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Lamivudine 10 mg/ml oral soln ![Compare how all Medicare Part D PDP plans in OH cover Lamivudine 10 mg/ml oral soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMIVUDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMIVUDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMIVUDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMIVUDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Lamivudine hbv 100 mg tablet ![Compare how all Medicare Part D PDP plans in OH cover Lamivudine hbv 100 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMIVUDINE-ZIDOVUDINE TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMIVUDINE-ZIDOVUDINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE 150MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE 150MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE 25 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE 25 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 200 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 250 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LAMOTRIGINE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover LAMOTRIGINE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LANSOPRAZOL-AMOXICIL-CLARITHRO ![Compare how all Medicare Part D PDP plans in OH cover LANSOPRAZOL-AMOXICIL-CLARITHRO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
![Compare how all Medicare Part D PDP plans in OH cover LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid] ![Compare how all Medicare Part D PDP plans in OH cover LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LANTHANUM CARB 1,000 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in OH cover LANTHANUM CARB 1,000 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LANTHANUM CARB 500 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in OH cover LANTHANUM CARB 500 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LANTHANUM CARB 750 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in OH cover LANTHANUM CARB 750 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:40 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in OH cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /28Days |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Larissia-28 tablet ![Compare how all Medicare Part D PDP plans in OH cover Larissia-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in OH cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LATUDA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LATUDA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 80 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LATUDA 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days |
LAZANDA 100 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in OH cover LAZANDA 100 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LAZANDA 300 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in OH cover LAZANDA 300 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LAZANDA 400 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in OH cover LAZANDA 400 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LEDIPASVIR-SOFOSBUVIR 90-400MG TABLET [Harvoni] ![Compare how all Medicare Part D PDP plans in OH cover LEDIPASVIR-SOFOSBUVIR 90-400MG TABLET [Harvoni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LEENA 28 TABLET [Tri-Norinyl] ![Compare how all Medicare Part D PDP plans in OH cover LEENA 28 TABLET [Tri-Norinyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
LEFLUNOMIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEFLUNOMIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEFLUNOMIDE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEFLUNOMIDE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 12 MG DAILY DOSE Capsule ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 12 MG DAILY DOSE Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OH cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in OH cover Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LETAIRIS 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LETAIRIS 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LETAIRIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LETAIRIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Leucovorin Calcium 15mg/1 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OH cover Leucovorin Calcium 15mg/1 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEUCOVORIN CALCIUM 25MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEUCOVORIN CALCIUM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEUCOVORIN CALCIUM 5 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LEUCOVORIN CALCIUM 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LEUKINE 250 MCG VIAL ![Compare how all Medicare Part D PDP plans in OH cover LEUKINE 250 MCG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in OH cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex] ![Compare how all Medicare Part D PDP plans in OH cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | Q:30 /30Days |
LEVETIRACETAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVETIRACETAM 100 MG/ML SOLN ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM 100 MG/ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVETIRACETAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVETIRACETAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVETIRACETAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVETIRACETAM ER 750 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVETIRACETAM ER 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOCARNITINE 1 G/10 ML SOLN ![Compare how all Medicare Part D PDP plans in OH cover LEVOCARNITINE 1 G/10 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOCETIRIZINE 2.5 MG/5 ML SOL ![Compare how all Medicare Part D PDP plans in OH cover LEVOCETIRIZINE 2.5 MG/5 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOCETIRIZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOCETIRIZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOFLOXACIN 500 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 500 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOFLOXACIN 750 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 750 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OH cover LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVONO-E ESTRAD 0.10-0.02-0.01 ![Compare how all Medicare Part D PDP plans in OH cover LEVONO-E ESTRAD 0.10-0.02-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:91 /84Days |
LEVONOR-ETH ESTRAD 0.1-0.02 MG ![Compare how all Medicare Part D PDP plans in OH cover LEVONOR-ETH ESTRAD 0.1-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in OH cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:91 /84Days |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in OH cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:91 /84Days |
Levonor-eth Estrad 0.15-0.03-0.01 ![Compare how all Medicare Part D PDP plans in OH cover Levonor-eth Estrad 0.15-0.03-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:91 /84Days |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in OH cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVONORG 0.15MG-EE 20-25-30MCG ![Compare how all Medicare Part D PDP plans in OH cover LEVONORG 0.15MG-EE 20-25-30MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:91 /84Days |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in OH cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OH cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
LIALDA 1.2G TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in OH cover LIALDA 1.2G TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LIDOCAINE 2% VISCOUS SOLN ![Compare how all Medicare Part D PDP plans in OH cover LIDOCAINE 2% VISCOUS SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LIDOCAINE 5% OINTMENT ![Compare how all Medicare Part D PDP plans in OH cover LIDOCAINE 5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | P Q:90 /30Days |
Lidocaine 5% patch ![Compare how all Medicare Part D PDP plans in OH cover Lidocaine 5% patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | P Q:90 /30Days |
LIDOCAINE HCL 2% JELLY 30ML TUBE ![Compare how all Medicare Part D PDP plans in OH cover LIDOCAINE HCL 2% JELLY 30ML TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
LIDOCAINE HCL IV 4% SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover LIDOCAINE HCL IV 4% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LIDOCAINE-PRILOCAINE CREAM ![Compare how all Medicare Part D PDP plans in OH cover LIDOCAINE-PRILOCAINE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Linezolid 20 MG/ML Oral Suspension [Zyvox] ![Compare how all Medicare Part D PDP plans in OH cover Linezolid 20 MG/ML Oral Suspension [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in OH cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LINEZOLID 600 MG/300 ML IV SOL [Zyvox] ![Compare how all Medicare Part D PDP plans in OH cover LINEZOLID 600 MG/300 ML IV SOL [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LIOTHYRONINE SOD 25 MCG TAB ![Compare how all Medicare Part D PDP plans in OH cover LIOTHYRONINE SOD 25 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LIOTHYRONINE SOD 5 MCG TAB ![Compare how all Medicare Part D PDP plans in OH cover LIOTHYRONINE SOD 5 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in OH cover LIOTHYRONINE SOD 50 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL-HCTZ 10-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL-HCTZ 20-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LISINOPRIL-HCTZ 20-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE 150 MG CAP ![Compare how all Medicare Part D PDP plans in OH cover LITHIUM CARBONATE 150 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE 300 MG Capsule [Eskalith] ![Compare how all Medicare Part D PDP plans in OH cover LITHIUM CARBONATE 300 MG Capsule [Eskalith].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lithium Carbonate 300 mg tab ![Compare how all Medicare Part D PDP plans in OH cover Lithium Carbonate 300 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Lithium Carbonate 450mg/1 ![Compare how all Medicare Part D PDP plans in OH cover Lithium Carbonate 450mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHIUM CARBONATE 600 MG CAP ![Compare how all Medicare Part D PDP plans in OH cover LITHIUM CARBONATE 600 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE ER 300 MG TB ![Compare how all Medicare Part D PDP plans in OH cover LITHIUM CARBONATE ER 300 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in OH cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
LIVALO 1 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LIVALO 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LIVALO 2 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LIVALO 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LIVALO 4 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LIVALO 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:30 /30Days |
LOKELMA 10 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in OH cover LOKELMA 10 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LOKELMA 5 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in OH cover LOKELMA 5 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LONHALA MAGNAIR 25 MCG STARTER VIAL-NEB ![Compare how all Medicare Part D PDP plans in OH cover LONHALA MAGNAIR 25 MCG STARTER VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:100 /28Days |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:80 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOPERAMIDE HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LOPERAMIDE HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in OH cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days |
LORAZEPAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORAZEPAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days |
LORAZEPAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORAZEPAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days |
LORAZEPAM 2 MG/ML ORAL CONCENT ![Compare how all Medicare Part D PDP plans in OH cover LORAZEPAM 2 MG/ML ORAL CONCENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:150 /30Days |
LORBRENA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORBRENA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LORBRENA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORBRENA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
LORCET HD 10-325 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LORCET HD 10-325 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:180 /30Days |
Lorcet plus 7.5-325 mg tablet ![Compare how all Medicare Part D PDP plans in OH cover Lorcet plus 7.5-325 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | Q:180 /30Days |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in OH cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOSARTAN POTASSIUM 100 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN POTASSIUM 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 25 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN POTASSIUM 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 50 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN POTASSIUM 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN-HCTZ 100-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-25 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN-HCTZ 100-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 50-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover LOSARTAN-HCTZ 50-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOTEMAX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in OH cover LOTEMAX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
LOTEMAX 0.5% OPHTHALMIC GEL ![Compare how all Medicare Part D PDP plans in OH cover LOTEMAX 0.5% OPHTHALMIC GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OH cover Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
LOTEMAX SM 0.38% OPHTH GEL DROPS ![Compare how all Medicare Part D PDP plans in OH cover LOTEMAX SM 0.38% OPHTH GEL DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
LOTEPREDNOL ETABONATE 0.5% EYE DROPPER [Lotemax] ![Compare how all Medicare Part D PDP plans in OH cover LOTEPREDNOL ETABONATE 0.5% EYE DROPPER [Lotemax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LOVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOW-OGESTREL-28 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LOW-OGESTREL-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LOXAPINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LOXAPINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LOXAPINE 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover LOXAPINE 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LOXAPINE CAPSULES 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in OH cover LOXAPINE CAPSULES 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LOXAPINE CAPSULES 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in OH cover LOXAPINE CAPSULES 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LUCEMYRA 0.18 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LUCEMYRA 0.18 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:228 /14Days |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in OH cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:3 /25Days |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LUPRON DEPOT 45 MG 6MO KIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT 45 MG 6MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in OH cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in OH cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:900 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
LYSODREN 500MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LYSODREN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $25.00 | None |