2019 Medicare Part D Plan Formulary Information |
UPMC for Life HMO Rx (HMO) (H3907-029-0)
Benefit Details
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The UPMC for Life HMO Rx (HMO) (H3907-029-0) Formulary Drugs Starting with the Letter B in Clinton County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $81.00 Deductible: $0 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in PA cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in PA cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BACLOFEN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BACLOFEN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BACLOFEN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BACLOFEN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in PA cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BALVERSA 3 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BALVERSA 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BALVERSA 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BALVERSA 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BALVERSA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BALVERSA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Balziva 6 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 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BANZEL TABLET 400MG ![Compare how all Medicare Part D PDP plans in PA cover BANZEL TABLET 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BASAGLAR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in PA cover BASAGLAR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | Q:45 /30Days |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BENAZEPRIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BENLYSTA 200 MG/ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in PA cover BENLYSTA 200 MG/ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
BENLYSTA 200 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover BENLYSTA 200 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
BENZNIDAZOLE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENZNIDAZOLE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BENZNIDAZOLE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BENZNIDAZOLE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BENZTROPINE MES 0.5 MG Tablet [Cogentin] ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE MES 0.5 MG Tablet [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in PA cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in PA cover BERINERT 500 UNIT KIT.](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 |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BETAMETHASONE DP 0.05% LOT ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Betamethasone DP 0.05% ointment ![Compare how all Medicare Part D PDP plans in PA cover Betamethasone DP 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BETAMETHASONE DP AUG 0.05% CRM ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BETAMETHASONE DP AUG 0.05% LOT ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BETAMETHASONE DP AUG 0.05% OIN ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE DP AUG 0.05% OIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETAMETHASONE VALERATE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETASERON 0.3 MG KIT ![Compare how all Medicare Part D PDP plans in PA cover BETASERON 0.3 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:14 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAXOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETAXOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETAXOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETAXOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Betaxolol 5 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in PA cover Betaxolol 5 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETHANECHOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETHANECHOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETHANECHOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETHANECHOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BETHANECHOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BETHKIS 300 MG/4 ML AMPULE ![Compare how all Medicare Part D PDP plans in PA cover BETHKIS 300 MG/4 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:224 /56Days |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in PA cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
BICALUTAMIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BICALUTAMIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in PA cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in PA cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BIKTARVY 50-200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BIKTARVY 50-200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
BISOPROLOL FUMARATE 10 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BISOPROLOL FUMARATE 5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL FUMARATE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BISOPROLOL-HCTZ 10-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL-HCTZ 10-6.25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BISOPROLOL-HCTZ 2.5-6.25 MG TB ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL-HCTZ 2.5-6.25 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BISOPROLOL-HCTZ 5-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover BISOPROLOL-HCTZ 5-6.25 MG TAB.](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 |
BIVIGAM LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover BIVIGAM LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in PA cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BLISOVI 24 FE TABLET ![Compare how all Medicare Part D PDP plans in PA cover BLISOVI 24 FE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BLISOVI FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in PA cover BLISOVI FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in PA cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BOSENTAN 125 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in PA cover BOSENTAN 125 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
BOSENTAN 62.5 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in PA cover BOSENTAN 62.5 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BOSULIF 400 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BOSULIF 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BOSULIF 500 MG TABLET.](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 |
BRAFTOVI 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BRAFTOVI 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BRAFTOVI 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BRAFTOVI 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:60 /30Days |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:60 /30Days |
BRIMONIDINE 0.2% EYE DROP ![Compare how all Medicare Part D PDP plans in PA cover BRIMONIDINE 0.2% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
BRIMONIDINE TARTRATE 0.15% DRP ![Compare how all Medicare Part D PDP plans in PA cover BRIMONIDINE TARTRATE 0.15% DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 10 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 10 MG/ML ORAL SOLN.](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 |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom] ![Compare how all Medicare Part D PDP plans in PA cover BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in PA cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in PA cover BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in PA cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |
BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS] ![Compare how all Medicare Part D PDP plans in PA cover BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUMETANIDE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUMETANIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUMETANIDE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUMETANIDE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:90 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:90 /30Days |
BUPRENORPHINE 10 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 10 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | S Q:4 /28Days |
BUPRENORPHINE 15 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 15 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | S Q:4 /28Days |
BUPRENORPHINE 2 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 2 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHINE 20 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 20 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | S Q:4 /28Days |
BUPRENORPHINE 5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | S Q:4 /28Days |
BUPRENORPHINE 7.5 MCG/HR PATCH Patch [Butrans] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 7.5 MCG/HR PATCH Patch [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | S Q:4 /28Days |
BUPRENORPHINE 8 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORPHINE 8 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | P Q:60 /30Days |
BUPROPION HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL SR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL SR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUSPIRONE HCL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUSPIRONE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUSPIRONE HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover BUSPIRONE HYDROCHLORIDE 10 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
BUTALB-ACETAMIN-CAFF 50-325-40 ![Compare how all Medicare Part D PDP plans in PA cover BUTALB-ACETAMIN-CAFF 50-325-40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days |
BUTALB-CAFF-ACETAMINOPH-CODEIN ![Compare how all Medicare Part D PDP plans in PA cover BUTALB-CAFF-ACETAMINOPH-CODEIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days |
BUTALBITAL COMP-CODEINE #3 CAP ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL COMP-CODEINE #3 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in PA cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None |