2019 Medicare Part D Plan Formulary Information |
Geisinger Gold Preferred Complete Rx (PPO) (H3924-060-13)
Benefit Details
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The Geisinger Gold Preferred Complete Rx (PPO) (H3924-060-13) Formulary Drugs Starting with the Letter B in Sullivan County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $0.00 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
BACLOFEN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BACLOFEN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 Q:90 /30Days |
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 Q:60 /30Days |
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 Q:30 /30Days |
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 |
$20.00 | $30.00 | 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 Brand |
$100.00 | $150.00 | 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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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 | None |
BAXDELA 300 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover BAXDELA 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
BAXDELA 450 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover BAXDELA 450 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /14Days |
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 Brand |
$100.00 | $150.00 | None |
BECONASE AQ 0.042% SPRAY ![Compare how all Medicare Part D PDP plans in PA cover BECONASE AQ 0.042% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
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 |
$3.00 | $4.50 | Q:60 /30Days |
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 |
$3.00 | $4.50 | Q:60 /30Days |
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 |
$3.00 | $4.50 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$3.00 | $4.50 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
BETAMETHASONE VALERATE 0.12% FOAM ![Compare how all Medicare Part D PDP plans in PA cover BETAMETHASONE VALERATE 0.12% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 | Q:14 /28Days |
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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in PA cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
BEVYXXA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BEVYXXA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BEVYXXA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BEVYXXA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:30 /30Days |
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 | None |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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 |
$20.00 | $30.00 | None |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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 Brand |
$100.00 | $150.00 | 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 Brand |
$100.00 | $150.00 | 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 | Q:30 /30Days |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
BIMATOPROST 0.03% EYE DROPS [Lumigan] ![Compare how all Medicare Part D PDP plans in PA cover BIMATOPROST 0.03% EYE DROPS [Lumigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$20.00 | $30.00 | 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 |
$3.00 | $4.50 | 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 |
$3.00 | $4.50 | 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 |
$3.00 | $4.50 | None |
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 |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | None |
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) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
BLEPHAMIDE EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover BLEPHAMIDE EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
BONJESTA ER 20-20 MG TABLET IR DR ![Compare how all Medicare Part D PDP plans in PA cover BONJESTA ER 20-20 MG TABLET IR DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Preferred Brand |
$47.00 | $70.50 | 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) |
3 |
Preferred Brand |
$47.00 | $70.50 | 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 Q:90 /30Days |
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 Q:30 /30Days |
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 Q:30 /30Days |
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 Q:120 /30Days |
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 Q:180 /30Days |
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 |
$47.00 | $70.50 | 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 |
$47.00 | $70.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$20.00 | $30.00 | 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) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
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) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:600 /30Days |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | P |
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 Brand |
$100.00 | $150.00 | None |
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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$20.00 | $30.00 | None |
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days |
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | Q:180 /30Days |
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | Q:180 /30Days |
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in PA cover BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days |
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 |
$20.00 | $30.00 | Q:360 /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 |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | Q:90 /30Days |
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) |
2 |
Generic |
$20.00 | $30.00 | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Generic |
$20.00 | $30.00 | 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) |
2 |
Generic |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | Q:90 /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 |
$20.00 | $30.00 | Q:180 /30Days |
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 |
$20.00 | $30.00 | Q:180 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:60 /30Days |
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 |
$20.00 | $30.00 | Q:30 /30Days |
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 |
$20.00 | $30.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL XL 450 MG TABLET ER 24H [Forfivo XL] ![Compare how all Medicare Part D PDP plans in PA cover BUPROPION HCL XL 450 MG TABLET ER 24H [Forfivo XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $30.00 | Q:30 /30Days |
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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 |
$20.00 | $30.00 | 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 Brand |
$100.00 | $150.00 | Q:180 /30Days |
BUTALBITAL-ASA-CAFFEINE CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL-ASA-CAFFEINE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:180 /30Days |
BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:180 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40 ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:180 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP ![Compare how all Medicare Part D PDP plans in PA cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Generic |
$20.00 | $30.00 | Q:5 /28Days |
BYDUREON 2 MG PEN INJECT ![Compare how all Medicare Part D PDP plans in PA cover BYDUREON 2 MG PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S Q:4 /28Days |
BYDUREON BCISE 2 MG AUTOINJECT ![Compare how all Medicare Part D PDP plans in PA cover BYDUREON BCISE 2 MG AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S Q:3 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in PA cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S Q:2 /30Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in PA cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S Q:1 /30Days |