Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


2019 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

BlueRx Essential (PDP) (S1030-006-0)
Tier 1 (76)
Tier 2 (615)
Tier 3 (786)
Tier 4 (574)
Tier 5 (657)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2019 Medicare Part D Plan Formulary Information
BlueRx Essential (PDP) (S1030-006-0)
Benefit Details           
The BlueRx Essential (PDP) (S1030-006-0)
Formulary Drugs Starting with the Letter B

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $34.40 Deductible: $415 Qualifies for LIS: No
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   4 Non-Preferred Drug 50%50%None
BACLOFEN 10 MG TABLET   2 Generic $4.00$8.00None
BACLOFEN 20 MG TABLET   2 Generic $4.00$8.00None
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT)   4 Non-Preferred Drug 50%50%None
BALVERSA 3 MG TABLET   5 Specialty Tier 25%25%P Q:90
/30Days
BALVERSA 4 MG TABLET   5 Specialty Tier 25%25%P Q:60
/30Days
BALVERSA 5 MG TABLET   5 Specialty Tier 25%25%P Q:30
/30Days
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK   3 Preferred Brand $47.00$94.00None
Banzel 200mg/1   4 Non-Preferred Drug 50%50%None
Banzel 40mg/mL   5 Specialty Tier 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BANZEL TABLET 400MG   5 Specialty Tier 25%25%None
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE   5 Specialty Tier 25%25%None
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL   3 Preferred Brand $47.00$94.00None
BENAZEPRIL HCL 10 MG TABLET   1 Preferred Generic $1.00$2.00None
BENAZEPRIL HCL 20 MG TABLET   1 Preferred Generic $1.00$2.00None
BENAZEPRIL HCL 40 MG TABLET   1 Preferred Generic $1.00$2.00None
BENAZEPRIL HCL 5 MG TABLET   1 Preferred Generic $1.00$2.00None
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT)   2 Generic $4.00$8.00None
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT)   2 Generic $4.00$8.00None
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT)   2 Generic $4.00$8.00None
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT)   2 Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BENLYSTA 200 MG/ML AUTOINJECT   5 Specialty Tier 25%25%P
BENLYSTA 200 MG/ML SYRINGE   5 Specialty Tier 25%25%P
BENZNIDAZOLE 100 MG TABLET   4 Non-Preferred Drug 50%50%None
BENZNIDAZOLE 12.5 MG TABLET   4 Non-Preferred Drug 50%50%None
BENZTROPINE MES 0.5 MG Tablet [Cogentin]   3 Preferred Brand $47.00$94.00P
BENZTROPINE MES 1 MG TABLET [Cogentin]   3 Preferred Brand $47.00$94.00P
BENZTROPINE MES 2 MG TABLET [Cogentin]   3 Preferred Brand $47.00$94.00P
BETASERON 0.3 MG KIT   5 Specialty Tier 25%25%P Q:15
/30Days
BETHANECHOL 10 MG TABLET   2 Generic $4.00$8.00None
BETHANECHOL 25 MG TABLET   3 Preferred Brand $47.00$94.00None
BETHANECHOL 5 MG TABLET   2 Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BETHANECHOL 50 MG TABLET   3 Preferred Brand $47.00$94.00None
BEVYXXA 40 MG CAPSULE   4 Non-Preferred Drug 50%50%Q:43
/42Days
BEVYXXA 80 MG CAPSULE   4 Non-Preferred Drug 50%50%Q:43
/42Days
BEXAROTENE 75 MG CAPSULE [Targretin]   5 Specialty Tier 25%25%P
BEXSERO PREFILLED SYRINGE   3 Preferred Brand $47.00$94.00None
BICALUTAMIDE 50 MG TABLET   3 Preferred Brand $47.00$94.00None
BICILL LA PFS 600MU 1ML PED   4 Non-Preferred Drug 50%50%None
BICILLIN LA PFS 1200MU 2ML   4 Non-Preferred Drug 50%50%None
BICILLIN LA. 600000UNIT/ML 1ML   4 Non-Preferred Drug 50%50%None
BIKTARVY 50-200-25 MG TABLET   5 Specialty Tier 25%25%Q:30
/30Days
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE   5 Specialty Tier 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BISOPROLOL FUMARATE 10 MG TAB   2 Generic $4.00$8.00None
BISOPROLOL FUMARATE 5 MG TAB   2 Generic $4.00$8.00None
BLISOVI 24 FE TABLET   3 Preferred Brand $47.00$94.00None
BLISOVI FE 1.5-30 TABLET   3 Preferred Brand $47.00$94.00None
BOOSTRIX TDAP VACCINE SYRINGE   3 Preferred Brand $47.00$94.00None
BOOSTRIX TDAP VACCINE VIAL   3 Preferred Brand $47.00$94.00None
BOSENTAN 125 MG TABLET [Tracleer]   5 Specialty Tier 25%25%P Q:60
/30Days
BOSENTAN 62.5 MG TABLET [Tracleer]   5 Specialty Tier 25%25%P Q:60
/30Days
BOSULIF 100 MG TABLET   5 Specialty Tier 25%25%P Q:180
/30Days
BOSULIF 400 MG TABLET   5 Specialty Tier 25%25%P Q:30
/30Days
BOSULIF 500 MG TABLET   5 Specialty Tier 25%25%P Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BRAFTOVI 50 MG CAPSULE   5 Specialty Tier 25%25%P Q:180
/30Days
BRAFTOVI 75 MG CAPSULE   5 Specialty Tier 25%25%P Q:180
/30Days
BREO ELLIPTA 100-25 MCG INH   3 Preferred Brand $47.00$94.00Q:60
/30Days
BREO ELLIPTA 200-25 MCG INH   3 Preferred Brand $47.00$94.00Q:60
/30Days
BRIELLYN TABLET   3 Preferred Brand $47.00$94.00None
BRILINTA 60 MG TABLET   3 Preferred Brand $47.00$94.00None
BRILINTA 90mg/1 60 TABLET BOTTLE   3 Preferred Brand $47.00$94.00None
BRIMONIDINE 0.2% EYE DROP   2 Generic $4.00$8.00None
BRIMONIDINE TARTRATE 0.15% DRP   4 Non-Preferred Drug 50%50%None
BRIVIACT 10 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 10 MG/ML ORAL SOLN   5 Specialty Tier 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BRIVIACT 100 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 25 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 50 MG TABLET   5 Specialty Tier 25%25%None
BRIVIACT 75 MG TABLET   5 Specialty Tier 25%25%None
BROMOCRIPTINE 2.5 MG TABLET [Parlodel]   4 Non-Preferred Drug 50%50%None
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 50%50%P
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 50%50%P
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort]   4 Non-Preferred Drug 50%50%P
BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC]   4 Non-Preferred Drug 50%50%None
BUMETANIDE 0.25MG/ML VIAL   3 Preferred Brand $47.00$94.00None
BUMETANIDE 0.5 MG TABLET   2 Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUMETANIDE 1 MG TABLET   2 Generic $4.00$8.00None
BUMETANIDE 2 MG TABLET   3 Preferred Brand $47.00$94.00None
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone]   2 Generic $4.00$8.00Q:60
/30Days
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone]   2 Generic $4.00$8.00Q:120
/30Days
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone]   2 Generic $4.00$8.00Q:30
/30Days
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone]   2 Generic $4.00$8.00Q:60
/30Days
BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone]   2 Generic $4.00$8.00Q:120
/30Days
BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone]   2 Generic $4.00$8.00Q:90
/30Days
BUPRENORPHINE 2 MG TABLET Subligual [Subutex]   2 Generic $4.00$8.00Q:90
/30Days
BUPRENORPHINE 8 MG TABLET Subligual [Subutex]   2 Generic $4.00$8.00Q:90
/30Days
BUPROPION HCL 100 MG TABLET   3 Preferred Brand $47.00$94.00Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPROPION HCL 75 MG TABLET   3 Preferred Brand $47.00$94.00Q:60
/30Days
BUPROPION HCL SR 100 MG TABLET   2 Generic $4.00$8.00Q:90
/30Days
BUPROPION HCL SR 150 MG TABLET   2 Generic $4.00$8.00Q:60
/30Days
BUPROPION HCL SR 150 MG TABLET   3 Preferred Brand $47.00$94.00None
BUPROPION HCL SR 200 MG TABLET   2 Generic $4.00$8.00Q:60
/30Days
BUPROPION HCL XL 150 MG TABLET   3 Preferred Brand $47.00$94.00Q:90
/30Days
BUPROPION HCL XL 300 MG TABLET   3 Preferred Brand $47.00$94.00Q:30
/30Days
BUSPIRONE HCL 15 MG TABLET   2 Generic $4.00$8.00None
BUSPIRONE HCL 30 MG TABLET   2 Generic $4.00$8.00None
BUSPIRONE HCL 5 MG TABLET   2 Generic $4.00$8.00None
BUSPIRONE HCL 7.5 MG TABLET   3 Preferred Brand $47.00$94.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS   2 Generic $4.00$8.00None
BUTALB-ACETAMIN-CAFF 50-325-40   4 Non-Preferred Drug 50%50%Q:180
/30Days
BUTALBITAL-ASA-CAFFEINE CAPSULE   4 Non-Preferred Drug 50%50%Q:180
/30Days
BYDUREON 2 MG PEN INJECT   3 Preferred Brand $47.00$94.00S Q:4
/28Days
BYDUREON BCISE 2 MG AUTOINJECT   3 Preferred Brand $47.00$94.00S Q:3
/28Days

Chart Legend:

Below are a few notes to help you understand the above 2019 Medicare Part D BlueRx Essential (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $415 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs. *Some Part D plans exclude one or more drug tiers from the deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3820) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2019 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.








Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.