2019 Medicare Part D Plan Formulary Information |
AARP MedicareRx Walgreens (PDP) (S5921-393-0)
Benefit Details
 |
The AARP MedicareRx Walgreens (PDP) (S5921-393-0) Formulary Drugs Starting with the Letter C in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $28.10 Deductible: $415 Qualifies for LIS: No |
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CABLIVI 11 MG KIT  |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
CABOMETYX 20 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
CABOMETYX 40 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
CABOMETYX 60 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
CALCIPOTRIENE 0.005% CREAM  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CALCIPOTRIENE 0.005% SOLUTION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Calcipotriene 50ug/g 60 g per CARTON  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:4 /28Days |
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in AL cover CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in AL cover CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | P |
CALCITRIOL 1MCG/ML SOLUTION ORAL  |
2* |
Generic |
$5.00 | $15.00 | P |
CALCITRIOL 3 MCG/G OINTMENT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CALCIUM ACETATE 667 MG TABLET [PhosLo] ![Compare how all Medicare Part D PDP plans in AL cover CALCIUM ACETATE 667 MG TABLET [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CALCIUM ACETATE CAPSULE 667 MG  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CALQUENCE 100 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
CAMILA 0.35 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CAMRESE LO TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CANASA 1,000 MG SUPPOSITORY  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CAPRELSA 100 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
CAPRELSA 300 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARAC CREAM  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CARAFATE SUS 1GM/10ML  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARBAGLU 200 MG DISPER TABLET  |
5 |
Specialty Tier |
25% | 25% | None |
CARBAMAZEPINE 100 MG TAB CHEW  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE 100 MG/5 ML SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE 200 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE ER 100 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in AL cover CARBAMAZEPINE ER 100 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE ER 100 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE ER 200 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in AL cover CARBAMAZEPINE ER 200 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE ER 300 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in AL cover CARBAMAZEPINE ER 300 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBAMAZEPINE XR 200 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE XR 400 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVO ER 25-100 TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVO ER 50-200 TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVODOPA 10-100 TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVODOPA 25-100 TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVODOPA 25-250 TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CARBIDOPA-LEVODOPA-ENTA 150 MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARBIDOPA-LEVODOPA-ENTA 75 MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVODOPA-ENTACAPONE 100 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in AL cover CARBIDOPA-LEVODOPA-ENTACAPONE 100 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 125 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in AL cover CARBIDOPA-LEVODOPA-ENTACAPONE 125 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 200 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in AL cover CARBIDOPA-LEVODOPA-ENTACAPONE 200 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in AL cover CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CARTEOLOL HCL 1% EYE DROPS  |
2* |
Generic |
$5.00 | $15.00 | None |
CARTIA XT 120MG CAPSULE SA  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARTIA XT 180MG CAPSULE SA  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARTIA XT 240MG CAPSULE SA  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARTIA XT 300 MG CAPSULE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CARVEDILOL 12.5 MG TABLET  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
CARVEDILOL 25 MG TABLET  |
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 |
CARVEDILOL 3.125 MG TABLET  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
CARVEDILOL 6.25 MG TABLET  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
CAYSTON KIT 75 MG/VIAL  |
5 |
Specialty Tier |
25% | 25% | P |
CEFACLOR 250 MG CAPSULES  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFACLOR 500 MG CAPSULES  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFADROXIL 250 MG/5 ML SUSP  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFADROXIL 500 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFADROXIL 500 MG/5 ML SUSP  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFAZOLIN 1 GM VIAL 25/Box  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFAZOLIN 500 MG VIAL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR 125 MG/5 ML SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFDINIR 250 MG/5 ML SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFDINIR 300 MG CAPSULE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFEPIME HCL 1 GM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in AL cover CEFEPIME HCL 1 GM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFEPIME HCL 2 GRAM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in AL cover CEFEPIME HCL 2 GRAM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFIXIME 100 MG/5 ML SUSP [Suprax] ![Compare how all Medicare Part D PDP plans in AL cover CEFIXIME 100 MG/5 ML SUSP [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFIXIME 200 MG/5 ML SUSP [Suprax] ![Compare how all Medicare Part D PDP plans in AL cover CEFIXIME 200 MG/5 ML SUSP [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
Cefotaxime 500 MG Injection  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Cefotaxime sodium 1 gm vial  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFOTETAN 1GM VIAL 1EA x 10  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFOTETAN 2GM VIAL 1EA x 10  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFOXITIN 1 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFOXITIN 10 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFOXITIN 2 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFPODOXIME 100 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFPODOXIME 100 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFPODOXIME 200 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFPODOXIME 50 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFPROZIL 125 MG/5 ML SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFPROZIL 250 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFPROZIL 250 MG/5 ML SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CEFPROZIL 500 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTAZIDIME 1 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTRIAXONE 1 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTRIAXONE 10 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTRIAXONE 2 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTRIAXONE 250 MG VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFTRIAXONE 500 MG VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEFUROXIME 750 MG FOR INJECTION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Cefuroxime 95 MG/ML Injectable Solution  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME AXETIL 250 MG TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CEFUROXIME AXETIL 500 MG TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
CELONTIN 300 MG KAPSEAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CEPHALEXIN 125 MG/5 ML SUSP  |
2* |
Generic |
$5.00 | $15.00 | None |
CEPHALEXIN 250 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CEPHALEXIN 250 MG/5 ML SUSP  |
2* |
Generic |
$5.00 | $15.00 | None |
CEPHALEXIN 500 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CEPHALEXIN 750 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CETIRIZINE HCL 1 MG/ML SOLN  |
2* |
Generic |
$5.00 | $15.00 | None |
CHANTIX 0.5 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHANTIX 1 MG CONT MONTH BOX  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHANTIX 1 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHANTIX STARTING MONTH BOX  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHEMET 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHENODAL 250 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | None |
CHLORDIAZEPOXIDE 10 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLORDIAZEPOXIDE 25 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLORDIAZEPOXIDE 5 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLORHEXIDINE GLUCONATE 0.12% RINSE  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLOROQUINE PH 250 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLOROQUINE PH 500 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLOROTHIAZIDE 250 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Chlorothiazide 500mg 100 TABLET BOTTLE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CHLORPROMAZINE 10 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHLORPROMAZINE 100 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHLORPROMAZINE 200 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHLORPROMAZINE 25 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHLORPROMAZINE 50 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CHLORTHALIDONE 25 MG TABLET (100 CT)  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLORTHALIDONE 50 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CHLORZOXAZONE 500 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CHOLBAM 250 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P |
CHOLBAM 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHOLESTYRAMINE LIGHT POWDER  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CHOLESTYRAMINE PACKET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CICLOPIROX 0.77% CREAM  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CICLOPIROX 0.77% GEL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CICLOPIROX 0.77% TOPICAL SUSP  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CICLOPIROX 1% SHAMPOO  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CICLOPIROX 8% SOLUTION  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Cilastatin 250 MG / Imipenem 250 MG Injection  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Cilastatin 500 MG / Imipenem 500 MG Injection  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CILOSTAZOL 100 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CILOSTAZOL 50 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIMDUO 300-300 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | Q:60 /30Days |
CINACALCET HCL 30 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in AL cover CINACALCET HCL 30 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
CINACALCET HCL 60 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in AL cover CINACALCET HCL 60 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
CINACALCET HCL 90 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in AL cover CINACALCET HCL 90 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:120 /30Days |
CIPROFLOXACIN 0.3% EYE DROP [Ciloxan] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN 0.3% EYE DROP [Ciloxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
CIPROFLOXACIN 250 MG TABLET (100 CT) [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN 250 MG TABLET (100 CT) [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
CIPROFLOXACIN 500 MG/5 ML SUSP MC REC [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN 500 MG/5 ML SUSP MC REC [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CIPROFLOXACIN HCL 500 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN HCL 500 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
CIPROFLOXACIN HCL 750 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN HCL 750 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CITALOPRAM HBR 10 MG TABLET  |
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 |
CITALOPRAM HBR 10 MG/5 ML SOLN  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CITALOPRAM HBR 20 MG TABLET  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
CITALOPRAM HBR 40 MG TABLET  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
CLARAVIS 10 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CLARAVIS 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CLARAVIS 40 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLARITHROMYCIN 250 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLARITHROMYCIN 500 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARITHROMYCIN ER 500 MG TAB  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLENPIQ 10-3.5/160  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clindamycin 150 MG/ML 2ml  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLINDAMYCIN 150mg/ml vl 25x6ml  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLINDAMYCIN 75 MG/5 ML SOLN  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLINDAMYCIN HCL 150 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CLINDAMYCIN HCL 300 MG CAPSULE  |
2* |
Generic |
$5.00 | $15.00 | None |
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE  |
2* |
Generic |
$5.00 | $15.00 | None |
CLINDAMYCIN PH 1% SOLUTION  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLINDAMYCIN PH 600 MG/4 ML VL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PHOSP 1% LOTION  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Clindamycin Phosphate and Benzoyl Peroxide 1 KIT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Clindamycin-d5w 300 mg/50 ml  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clindamycin-d5w 600 mg/50 ml  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clindamycin-d5w 900 mg/50 ml  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOBAZAM 10 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in AL cover CLOBAZAM 10 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | P Q:60 /30Days |
CLOBAZAM 2.5 MG/ML Oral Suspension [ONFI] ![Compare how all Medicare Part D PDP plans in AL cover CLOBAZAM 2.5 MG/ML Oral Suspension [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | P |
CLOBAZAM 20 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in AL cover CLOBAZAM 20 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBETASOL 0.05% CREAM (g) [Temovate] ![Compare how all Medicare Part D PDP plans in AL cover CLOBETASOL 0.05% CREAM (g) [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOBETASOL 0.05% OINTMENT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOBETASOL 0.05% SOLUTION  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLOBETASOL EMOLLIENT 0.05% CREAM (g) [Temovate E] ![Compare how all Medicare Part D PDP plans in AL cover CLOBETASOL EMOLLIENT 0.05% CREAM (g) [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clobetasol Propionate 0.5 MG/ML Medicated Shampoo  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOMIPRAMINE 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOMIPRAMINE 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOMIPRAMINE 75 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLONAZEPAM 0.125 MG DIS TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 0.125 MG DIS TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:120 /30Days |
CLONAZEPAM 0.25 MG ODT TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 0.25 MG ODT TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:120 /30Days |
CLONAZEPAM 0.5 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 0.5 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | Q:120 /30Days |
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:120 /30Days |
CLONAZEPAM 1 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 1 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | Q:120 /30Days |
CLONAZEPAM 2 MG ODT TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 2 MG ODT TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:300 /30Days |
CLONAZEPAM 2 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in AL cover CLONAZEPAM 2 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | Q:300 /30Days |
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLONIDINE HCL 0.1 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CLONIDINE HCL 0.2 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE HCL 0.3 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CLONIDINE HCL ER 0.1 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in AL cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | Q:120 /30Days |
CLORAZEPATE 15 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:180 /30Days |
CLORAZEPATE 3.75 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:720 /30Days |
CLORAZEPATE 7.5 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:360 /30Days |
CLOTRIMAZOLE 1% CREAM  |
2* |
Generic |
$5.00 | $15.00 | None |
CLOTRIMAZOLE 1% SOLUTION  |
2* |
Generic |
$5.00 | $15.00 | None |
CLOTRIMAZOLE 10 MG TROCHE  |
2* |
Generic |
$5.00 | $15.00 | None |
CLOTRIMAZOLE-BETAMETHASONE LOT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE 100 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE 100 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLOZAPINE 200 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLOZAPINE 25 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE 25 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLOZAPINE 50 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:270 /30Days |
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:60 /30Days |
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:180 /30Days |
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:120 /30Days |
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in AL cover CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:90 /30Days |
COARTEM 20MG-120MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CODEINE SULFATE 30 mg tablet  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CODEINE SULFATE 60 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:180 /30Days |
COLCHICINE 0.6 MG CAPSULE [Mitigare] ![Compare how all Medicare Part D PDP plans in AL cover COLCHICINE 0.6 MG CAPSULE [Mitigare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:120 /30Days |
COLCHICINE 0.6 MG TABLET [Colcrys] ![Compare how all Medicare Part D PDP plans in AL cover COLCHICINE 0.6 MG TABLET [Colcrys].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:120 /30Days |
COLCRYS 0.6 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:120 /30Days |
COLESTIPOL HCL 1G TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
COLESTIPOL HCL GRANULES PACKET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
COLISTIMETHATE 150 MG VIAL [Coly-Mycin M] ![Compare how all Medicare Part D PDP plans in AL cover COLISTIMETHATE 150 MG VIAL [Coly-Mycin M].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
COLOCORT 100MG ENEMA  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
COLY-MYCIN S OTIC SUSP DROP  |
4 |
Non-Preferred Drug |
32% | 32% | None |
COMBIVENT RESPIMAT INHAL SPRAY  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
COMETRIQ 100 MG DAILY-DOSE PK  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMETRIQ 140 MG DAILY-DOSE PK  |
5 |
Specialty Tier |
25% | 25% | P |
COMETRIQ 60 MG DAILY-DOSE PACK  |
5 |
Specialty Tier |
25% | 25% | P |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1  |
5 |
Specialty Tier |
25% | 25% | Q:60 /30Days |
COMPRO 25MG SUPPOSITORY  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CONSTULOSE 10 GM/15 ML SOLN  |
2* |
Generic |
$5.00 | $15.00 | None |
COPIKTRA 15 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
COPIKTRA 25 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:60 /30Days |
CORLANOR 5 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:60 /30Days |
CORLANOR 7.5 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:60 /30Days |
COSENTYX 300 MG DOSE-2 PENS  |
5 |
Specialty Tier |
25% | 25% | P |
COSOPT PF EYE DROPS  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COTELLIC 20 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:90 /30Days |
CRINONE 4% GEL GEL/PF APP  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CRINONE 8% GEL/PF APP  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CRIXIVAN 200MG CAPSULE  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:270 /30Days |
CRIXIVAN 400mg, 180 CAPSULE BOTTLE  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:270 /30Days |
CROMOLYN 20 MG/2 ML NEB SOLN  |
3 |
Preferred Brand |
$30.00 | $90.00 | P |
CROMOLYN SODIUM 100 MG/5 ML  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CROMOLYN SODIUM 4% 40MG 10ML BOT  |
2* |
Generic |
$5.00 | $15.00 | None |
CUVPOSA 1 MG/5 ML SOLUTION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CYCLOBENZAPRINE 10 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOBENZAPRINE 5 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
CYCLOPHOSPHAMIDE 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE 100MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE 25MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE MODIFIED 100 MG  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE MODIFIED 25 MG  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE MODIFIED 50 MG  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT  |
4 |
Non-Preferred Drug |
32% | 32% | P |
CYPROHEPTADINE 4 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYRED EQ 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in AL cover CYRED EQ 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
CYSTADANE 1 GRAM/1.7 ML POWDER  |
5 |
Specialty Tier |
25% | 25% | None |
CYSTAGON 150MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CYSTAGON 50MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
CYSTARAN 0.44% EYE DROPS  |
5 |
Specialty Tier |
25% | 25% | None |