2019 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-257-0)
Benefit Details
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The Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-257-0) Formulary Drugs Starting with the Letter C in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $57.90 Deductible: $100 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 |
50% | 50% | Q:16 /28Days |
CABOMETYX 20 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
CABOMETYX 40 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
CABOMETYX 60 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
CALCIPOTRIENE 0.005% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | Q:120 /30Days |
CALCIPOTRIENE 0.005% SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
Calcipotriene 50ug/g 60 g per CARTON  |
4 |
Non-Preferred Drug |
50% | 50% | Q:120 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY  |
2* |
Generic |
$10.00 | $25.00 | Q:4 /30Days |
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 |
$10.00 | $25.00 | None |
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 |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 1MCG/ML SOLUTION ORAL  |
2* |
Generic |
$10.00 | $25.00 | None |
CALCITRIOL 3 MCG/G OINTMENT  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:800 /30Days |
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 |
$42.00 | $105.00 | None |
CALCIUM ACETATE CAPSULE 667 MG  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CALQUENCE 100 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
CAMILA 0.35 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CAMRESE LO TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days |
CANDESARTAN CILEXETIL 16 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in AL cover CANDESARTAN CILEXETIL 16 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
CANDESARTAN CILEXETIL 32 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in AL cover CANDESARTAN CILEXETIL 32 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
CANDESARTAN CILEXETIL 4 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in AL cover CANDESARTAN CILEXETIL 4 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
CANDESARTAN CILEXETIL 8 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in AL cover CANDESARTAN CILEXETIL 8 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
candesartan-hctz 16-12.5 mg tablet  |
2* |
Generic |
$10.00 | $25.00 | None |
candesartan-hctz 32-12.5 mg tablet  |
2* |
Generic |
$10.00 | $25.00 | None |
CANDESARTAN-HCTZ 32-25 MG TAB  |
2* |
Generic |
$10.00 | $25.00 | None |
CAPRELSA 100 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
CAPRELSA 300 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
CAPTOPRIL 100MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CAPTOPRIL 12.5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CAPTOPRIL 25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CAPTOPRIL 50MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CARAFATE SUS 1GM/10ML  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CARBAGLU 200 MG DISPER TABLET  |
5 |
Specialty Tier |
31% | N/A | P |
CARBAMAZEPINE 100 MG TAB CHEW  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBAMAZEPINE 100 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBAMAZEPINE 200 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | 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) |
2* |
Generic |
$10.00 | $25.00 | None |
CARBAMAZEPINE ER 100 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | 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) |
2* |
Generic |
$10.00 | $25.00 | 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) |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE XR 200 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CARBAMAZEPINE XR 400 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVO ER 25-100 TAB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CARBIDOPA-LEVO ER 50-200 TAB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CARBIDOPA-LEVODOPA 10-100 TAB  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA 25-100 TAB  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA 25-250 TAB  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA-ENTA 150 MG  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVODOPA-ENTA 75 MG  |
4 |
Non-Preferred Drug |
50% | 50% | None |
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 |
50% | 50% | 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 |
50% | 50% | 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 |
50% | 50% | 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 |
50% | 50% | None |
CARTEOLOL HCL 1% EYE DROPS  |
2* |
Generic |
$10.00 | $25.00 | None |
CARTIA XT 120MG CAPSULE SA  |
2* |
Generic |
$10.00 | $25.00 | None |
CARTIA XT 180MG CAPSULE SA  |
2* |
Generic |
$10.00 | $25.00 | None |
CARTIA XT 240MG CAPSULE SA  |
2* |
Generic |
$10.00 | $25.00 | None |
CARTIA XT 300 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CARVEDILOL 12.5 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARVEDILOL 25 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CARVEDILOL 3.125 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CARVEDILOL 6.25 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CARVEDILOL ER 10 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
CARVEDILOL ER 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
CARVEDILOL ER 40 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
CARVEDILOL ER 80 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
CASPOFUNGIN ACETATE 50 MG VIAL  |
5 |
Specialty Tier |
31% | N/A | P |
CASPOFUNGIN ACETATE 70 MG VIAL  |
5 |
Specialty Tier |
31% | N/A | P |
CAYSTON KIT 75 MG/VIAL  |
5 |
Specialty Tier |
31% | N/A | P Q:84 /56Days |
CAZIANT 28 DAY TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR 125 MG/5 ML SUSP Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in AL cover CEFACLOR 125 MG/5 ML SUSP Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFACLOR 250 MG CAPSULES  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFACLOR 250 MG/5 ML SUSPEN Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in AL cover CEFACLOR 250 MG/5 ML SUSPEN Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFACLOR 375 MG/5 ML SUSPEN Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in AL cover CEFACLOR 375 MG/5 ML SUSPEN Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFACLOR 500 MG CAPSULES  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFACLOR ER 500MG TABLET SR 12HR  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFADROXIL 1 GM TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFADROXIL 250 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFADROXIL 500 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFADROXIL 500 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFAZOLIN 1 GM VIAL 25/Box  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFAZOLIN 500 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFDINIR 125 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFDINIR 250 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFDINIR 300 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | 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 |
50% | 50% | 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 |
50% | 50% | 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 |
50% | 50% | 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 |
50% | 50% | None |
Cefotaxime 500 MG Injection  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Cefotaxime sodium 1 gm vial  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFOTETAN 1GM VIAL 1EA x 10  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFOTETAN 2GM VIAL 1EA x 10  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFOXITIN 1 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFOXITIN 10 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFOXITIN 2 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFPODOXIME 100 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFPODOXIME 100 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFPODOXIME 200 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFPODOXIME 50 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFPROZIL 125 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFPROZIL 250 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFPROZIL 250 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFPROZIL 500 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFTAZIDIME 1 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTRIAXONE 1 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTRIAXONE 10 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTRIAXONE 2 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTRIAXONE 250 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFTRIAXONE 500 MG VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME 750 MG FOR INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Cefuroxime 95 MG/ML Injectable Solution  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CEFUROXIME AXETIL 250 MG TAB  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CEFUROXIME AXETIL 500 MG TAB  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in AL cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in AL cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in AL cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in AL cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
CELONTIN 300 MG KAPSEAL  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CEPHALEXIN 125 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEPHALEXIN 250 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 250 MG/5 ML SUSP  |
2* |
Generic |
$10.00 | $25.00 | None |
CEPHALEXIN 500 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CHANTIX 0.5 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:56 /28Days |
CHANTIX 1 MG CONT MONTH BOX  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:56 /28Days |
CHANTIX 1 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:56 /28Days |
CHANTIX STARTING MONTH BOX  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:56 /28Days |
CHEMET 100 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | None |
CHLORHEXIDINE GLUCONATE 0.12% RINSE  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CHLOROQUINE PH 250 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CHLOROQUINE PH 500 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CHLOROTHIAZIDE 250 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Chlorothiazide 500mg 100 TABLET BOTTLE  |
2* |
Generic |
$10.00 | $25.00 | None |
CHLORPROMAZINE 10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHLORPROMAZINE 100 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHLORPROMAZINE 200 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHLORPROMAZINE 25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHLORPROMAZINE 50 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHLORTHALIDONE 25 MG TABLET (100 CT)  |
2* |
Generic |
$10.00 | $25.00 | None |
CHLORTHALIDONE 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CHOLESTYRAMINE LIGHT POWDER  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CHOLESTYRAMINE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CICLOPIROX 0.77% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CICLOPIROX 0.77% TOPICAL SUSP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CICLOPIROX 1% SHAMPOO  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CICLOPIROX 8% SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Cilastatin 250 MG / Imipenem 250 MG Injection  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Cilastatin 500 MG / Imipenem 500 MG Injection  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CILOSTAZOL 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CILOSTAZOL 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CILOXAN 0.3% OINTMENT  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CIMDUO 300-300 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in AL cover Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:20 /30Days |
CIPRO HC OTIC SUSPENSION  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPRODEX OTIC SUSPENSION  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
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 |
$10.00 | $25.00 | 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 |
$10.00 | $25.00 | 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 |
50% | 50% | None |
CIPROFLOXACIN HCL 100 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in AL cover CIPROFLOXACIN HCL 100 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | 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 |
$10.00 | $25.00 | 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 |
$10.00 | $25.00 | 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 |
50% | 50% | None |
CITALOPRAM HBR 10 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CITALOPRAM HBR 10 MG/5 ML SOLN  |
4 |
Non-Preferred Drug |
50% | 50% | Q:600 /30Days |
CITALOPRAM HBR 20 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CITALOPRAM HBR 40 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | Q:30 /30Days |
CLARAVIS 10 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARAVIS 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARAVIS 40 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARITHROMYCIN 250 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARITHROMYCIN 500 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLARITHROMYCIN ER 500 MG TAB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDACIN PAC KIT  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clindamycin 150 MG/ML 2ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN 150mg/ml vl 25x6ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN HCL 150 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN HCL 300 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE  |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN PH 1% SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN PH 600 MG/4 ML VL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN PHOSP 1% LOTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX  |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clindamycin-d5w 300 mg/50 ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clindamycin-d5w 600 mg/50 ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clindamycin-d5w 900 mg/50 ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLINIMIX 4.25%-25% SOLUTION IV SOLN  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLINIMIX 5/20 SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLINIMIX 5%-15% SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLINISOL 15% SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
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 |
50% | 50% | 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 |
50% | 50% | Q:480 /30Days |
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 |
50% | 50% | 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) |
2* |
Generic |
$10.00 | $25.00 | None |
CLOBETASOL 0.05% OINTMENT  |
2* |
Generic |
$10.00 | $25.00 | None |
CLOBETASOL 0.05% SOLUTION  |
2* |
Generic |
$10.00 | $25.00 | None |
CLOBETASOL 0.05% TOPICAL LOTN  |
4 |
Non-Preferred Drug |
50% | 50% | 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) |
2* |
Generic |
$10.00 | $25.00 | None |
CLOBETASOL EMOLLNT 0.05% FOAM [Olux-E] ![Compare how all Medicare Part D PDP plans in AL cover CLOBETASOL EMOLLNT 0.05% FOAM [Olux-E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLOBETASOL PROP 0.05% SPRAY  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clobetasol Propionate 0.5 MG/ML Medicated Shampoo  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clobetasol Propionate 0.5mg/g 1 CAN per CARTON / 100 g in 1 CAN  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE  |
2* |
Generic |
$10.00 | $25.00 | None |
CLOBEX 0.05% SPRAY  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBEX 0.05% TOPICAL LOTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clobex 0.05mL/100mL 118 mL in 1 BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Clodan 0.05% shampoo  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLOMIPRAMINE 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLOMIPRAMINE 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CLOMIPRAMINE 75 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
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 |
50% | 50% | Q:90 /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 |
50% | 50% | Q:90 /30Days |
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 |
50% | 50% | Q:90 /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 |
$10.00 | $25.00 | Q:90 /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 |
50% | 50% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$10.00 | $25.00 | 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 |
50% | 50% | 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 |
$10.00 | $25.00 | Q:300 /30Days |
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
CLONIDINE HCL 0.1 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CLONIDINE HCL 0.2 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
CLONIDINE HCL 0.3 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CLONIDINE HCL ER 0.1 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:120 /30Days |
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 |
$10.00 | $25.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLORAZEPATE 15 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
CLORAZEPATE 3.75 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:90 /30Days |
CLORAZEPATE 7.5 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:90 /30Days |
CLOTRIMAZOLE 1% CREAM  |
2* |
Generic |
$10.00 | $25.00 | None |
CLOTRIMAZOLE 1% SOLUTION  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CLOTRIMAZOLE 10 MG TROCHE  |
2* |
Generic |
$10.00 | $25.00 | None |
CLOTRIMAZOLE-BETAMETHASONE LOT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE  |
2* |
Generic |
$10.00 | $25.00 | None |
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) |
4 |
Non-Preferred Drug |
50% | 50% | Q:270 /30Days |
CLOZAPINE 200 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:120 /30Days |
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 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE 50 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | 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 |
50% | 50% | 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 |
50% | 50% | None |
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 |
50% | 50% | 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) |
5 |
Specialty Tier |
31% | N/A | 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 |
50% | 50% | None |
COARTEM 20MG-120MG  |
4 |
Non-Preferred Drug |
50% | 50% | Q:24 /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 |
$42.00 | $105.00 | Q:60 /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 |
$42.00 | $105.00 | Q:120 /30Days |
COLESTIPOL HCL 1G TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COLESTIPOL HCL GRANULES PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
50% | 50% | None |
COLOCORT 100MG ENEMA  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COMBIGAN 0.2%-0.5% DROPS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
COMBIVENT RESPIMAT INHAL SPRAY  |
4 |
Non-Preferred Drug |
50% | 50% | Q:8 /30Days |
COMETRIQ 100 MG DAILY-DOSE PK  |
5 |
Specialty Tier |
31% | N/A | P Q:56 /28Days |
COMETRIQ 140 MG DAILY-DOSE PK  |
5 |
Specialty Tier |
31% | N/A | P Q:112 /28Days |
COMETRIQ 60 MG DAILY-DOSE PACK  |
5 |
Specialty Tier |
31% | N/A | P Q:84 /28Days |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
COMPRO 25MG SUPPOSITORY  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CONSTULOSE 10 GM/15 ML SOLN  |
2* |
Generic |
$10.00 | $25.00 | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COPAXONE 40 MG/ML SYRINGE  |
5 |
Specialty Tier |
31% | N/A | P Q:12 /28Days |
COPIKTRA 15 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
COPIKTRA 25 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
CORLANOR 5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
CORLANOR 7.5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
Cortisone 25 MG Tablet  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COTELLIC 20 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:63 /28Days |
COUMADIN 1 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 10MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 2.5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 2MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COUMADIN 3mg/1 1 BOTTLE per CARTON / 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 4mg/1 1 BOTTLE in 1 CARTON / 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 6MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
COUMADIN 7.5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CREON DR 36,000 UNITS CAPSULE  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
CRIXIVAN 200MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:270 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CRIXIVAN 400mg, 180 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days |
CROMOLYN 20 MG/2 ML NEB SOLN  |
2* |
Generic |
$10.00 | $25.00 | P Q:240 /30Days |
CROMOLYN SODIUM 100 MG/5 ML  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CROMOLYN SODIUM 4% 40MG 10ML BOT  |
2* |
Generic |
$10.00 | $25.00 | None |
CUPRIMINE 250 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | None |
Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK  |
2* |
Generic |
$10.00 | $25.00 | None |
CYCLAFEM 7-7-7-28 TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CYCLOBENZAPRINE 10 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | P Q:90 /30Days |
CYCLOBENZAPRINE 5 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | P Q:90 /30Days |
CYCLOPHOSPHAMIDE 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOSET 0.8MG TABLETS  |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days |
CYCLOSPORINE 100MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOSPORINE 25MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOSPORINE MODIFIED 100 MG  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOSPORINE MODIFIED 25 MG  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOSPORINE MODIFIED 50 MG  |
4 |
Non-Preferred Drug |
50% | 50% | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT  |
4 |
Non-Preferred Drug |
50% | 50% | P |
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) |
2* |
Generic |
$10.00 | $25.00 | None |
CYSTADANE 1 GRAM/1.7 ML POWDER  |
5 |
Specialty Tier |
31% | N/A | None |
CYSTAGON 150MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
CYSTAGON 50MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYSTARAN 0.44% EYE DROPS  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /28Days |