2019 Medicare Part D Plan Formulary Information |
Gateway Health Medicare Assured Ruby (HMO SNP) (H5932-009-0)
Benefit Details
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The Gateway Health Medicare Assured Ruby (HMO SNP) (H5932-009-0) Formulary Drugs Starting with the Letter V in Cambria County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $37.00 Deductible: $415 |
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VALACYCLOVIR HCL 1 GRAM TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALACYCLOVIR HCL 1 GRAM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VALACYCLOVIR HCL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VALACYCLOVIR HCL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VALCHLOR 0.016% GEL ![Compare how all Medicare Part D PDP plans in PA cover VALCHLOR 0.016% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VALGANCICLOVIR 450 MG TABLET [Valcyte] ![Compare how all Medicare Part D PDP plans in PA cover VALGANCICLOVIR 450 MG TABLET [Valcyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VALGANCICLOVIR HCL 50 MG/ML [Valcyte] ![Compare how all Medicare Part D PDP plans in PA cover VALGANCICLOVIR HCL 50 MG/ML [Valcyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VALPROIC ACID 250 MG CAPSULE [Depakene] ![Compare how all Medicare Part D PDP plans in PA cover VALPROIC ACID 250 MG CAPSULE [Depakene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VALPROIC ACID 250 MG/5 ML SOLN Solution [Depakene] ![Compare how all Medicare Part D PDP plans in PA cover VALPROIC ACID 250 MG/5 ML SOLN Solution [Depakene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VALSARTAN 160 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN 160 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN 320 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN 320 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN 40 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN 40 MG TABLET [Diovan].](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 |
VALSARTAN 80 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN 80 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN-HCTZ 160-12.5 MG TAB [Diovan HCT] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 160-12.5 MG TAB [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN-HCTZ 160-25 MG TAB [Diovan HCT] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 160-25 MG TAB [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN-HCTZ 320-12.5 MG TAB [Diovan HCT] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 320-12.5 MG TAB [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN-HCTZ 320-25 MG TAB [Diovan HCT] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 320-25 MG TAB [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VALSARTAN-HCTZ 80-12.5 MG Tablet [Diovan HCT] ![Compare how all Medicare Part D PDP plans in PA cover VALSARTAN-HCTZ 80-12.5 MG Tablet [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VANCOMYCIN 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VANCOMYCIN HCL 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VANCOMYCIN HCL 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VANCOMYCIN HCL 250 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 250 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VANCOMYCIN HCL 750 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL 750 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ) ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VANCOMYCIN HYDROCHLORIDE 100MG/ML 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA ![Compare how all Medicare Part D PDP plans in PA cover VANCOMYCIN HYDROCHLORIDE 100MG/ML 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VAQTA 25 UNITS/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover VAQTA 25 UNITS/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VAQTA 50 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover VAQTA 50 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
Vaqta Hepatitis A Vaccine Adult 50 Unit / mL Injection Single Dose Vial 1 mL ![Compare how all Medicare Part D PDP plans in PA cover Vaqta Hepatitis A Vaccine Adult 50 Unit / mL Injection Single Dose Vial 1 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
Vaqta Hepatitis A Vaccine Pediatric / Adolescent 25 Unit / 0.5 mL Injection Single Dose Vial 0.5 mL ![Compare how all Medicare Part D PDP plans in PA cover Vaqta Hepatitis A Vaccine Pediatric / Adolescent 25 Unit / 0.5 mL Injection Single Dose Vial 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in PA cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VARIZIG 125 UNIT/1.2 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover VARIZIG 125 UNIT/1.2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VELIVET 28 DAY TABLET [Velivet] ![Compare how all Medicare Part D PDP plans in PA cover VELIVET 28 DAY TABLET [Velivet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VENCLEXTA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENCLEXTA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VENCLEXTA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENCLEXTA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENCLEXTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VENCLEXTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VENCLEXTA STARTING PACK ![Compare how all Medicare Part D PDP plans in PA cover VENCLEXTA STARTING PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Venlafaxine 24 HR 225 MG Extended Release Oral Tablet ![Compare how all Medicare Part D PDP plans in PA cover Venlafaxine 24 HR 225 MG Extended Release Oral Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL 100 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 100 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL 25 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 25 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL 37.5 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 37.5 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL 50 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 50 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL 75 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL 75 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL ER 150 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 150 MG CAPSULE 24H [Effexor XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL ER 150 MG TABLET 24 [Venlafaxine] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 150 MG TABLET 24 [Venlafaxine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL ER 37.5 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 37.5 MG CAPSULE 24H [Effexor XR].](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 |
VENLAFAXINE HCL ER 37.5 MG TAB ER 24 [Venlafaxine] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 37.5 MG TAB ER 24 [Venlafaxine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL ER 75 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 75 MG CAPSULE 24H [Effexor XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VENLAFAXINE HCL ER 75 MG TABLET 24 [Venlafaxine] ![Compare how all Medicare Part D PDP plans in PA cover VENLAFAXINE HCL ER 75 MG TABLET 24 [Venlafaxine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Ventavis 0.01mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Ventavis 0.01mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Ventavis 0.02mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Ventavis 0.02mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in PA cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:36 /30Days |
VERAPAMIL 120 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 40MG 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 |
VERAPAMIL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VERAPAMIL ER 180 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL ER 240 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER 240 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VERAPAMIL ER PM 300 MG CAPSULE 24H PCT [Verelan PM] ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL ER PM 300 MG CAPSULE 24H PCT [Verelan PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VERAPAMIL HCL 360MG CAPSULES SUSTAINED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover VERAPAMIL HCL 360MG CAPSULES SUSTAINED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VERSACLOZ 50 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover VERSACLOZ 50 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:540 /30Days |
VERZENIO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERZENIO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
VERZENIO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERZENIO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERZENIO 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERZENIO 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
VERZENIO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VERZENIO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
VIBRAMYCIN 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover VIBRAMYCIN 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VICTOZA 3-PAK 18 MG/3 ML PEN ![Compare how all Medicare Part D PDP plans in PA cover VICTOZA 3-PAK 18 MG/3 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:9 /30Days |
VIDEX 4 GM PEDIATRIC SOLN ![Compare how all Medicare Part D PDP plans in PA cover VIDEX 4 GM PEDIATRIC SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VIENVA-28 TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIENVA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL] ![Compare how all Medicare Part D PDP plans in PA cover VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VIGABATRIN 500 MG POWDER PACKET [SABRIL] ![Compare how all Medicare Part D PDP plans in PA cover VIGABATRIN 500 MG POWDER PACKET [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
VIGABATRIN 500 MG TABLET [Sabril] ![Compare how all Medicare Part D PDP plans in PA cover VIGABATRIN 500 MG TABLET [Sabril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
VIGADRONE 500 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in PA cover VIGADRONE 500 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover VIGAMOX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
VIIBRYD 10-20 MG STARTER PACK ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 10-20 MG STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 10mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 20mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
VIMPAT 10 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover VIMPAT 10 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:1200 /30Days |
Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 100mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 150mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 200mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Vimpat 50mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VIREAD 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VIREAD 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VIREAD 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIREAD 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VIREAD POWDER ![Compare how all Medicare Part D PDP plans in PA cover VIREAD POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VITRAKVI 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VITRAKVI 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VITRAKVI 20 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover VITRAKVI 20 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VITRAKVI 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover VITRAKVI 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
VIZIMPRO 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIZIMPRO 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
VIZIMPRO 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIZIMPRO 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIZIMPRO 45 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VIZIMPRO 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
VORICONAZOLE 200 MG TABLET [VFEND] ![Compare how all Medicare Part D PDP plans in PA cover VORICONAZOLE 200 MG TABLET [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VORICONAZOLE 200 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover VORICONAZOLE 200 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
Voriconazole 40 MG/ML Oral Suspension ![Compare how all Medicare Part D PDP plans in PA cover Voriconazole 40 MG/ML Oral Suspension.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VORICONAZOLE 50 MG TABLET [VFEND] ![Compare how all Medicare Part D PDP plans in PA cover VORICONAZOLE 50 MG TABLET [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
VOSEVI 400-100-100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VOSEVI 400-100-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
VOTRIENT 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover VOTRIENT 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:120 /30Days |
VRAYLAR 1.5 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover VRAYLAR 1.5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
VRAYLAR 1.5 MG-3 MG PACK ![Compare how all Medicare Part D PDP plans in PA cover VRAYLAR 1.5 MG-3 MG PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VRAYLAR 3 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover VRAYLAR 3 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
VRAYLAR 4.5 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover VRAYLAR 4.5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VRAYLAR 6 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover VRAYLAR 6 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
Vyfemla 28 tablet ![Compare how all Medicare Part D PDP plans in PA cover Vyfemla 28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |
VYLIBRA 28 TABLET ![Compare how all Medicare Part D PDP plans in PA cover VYLIBRA 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $60.00 | None |