2019 Medicare Part D Plan Formulary Information |
WellCare Classic (PDP) (S4802-071-0)
Benefit Details
 |
The WellCare Classic (PDP) (S4802-071-0) Formulary Drugs Starting with the Letter E in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $29.90 Deductible: $415 Qualifies for LIS: Yes |
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
E.E.S. 400 FILMTAB  |
4 |
Non-Preferred Drug |
42% | 42% | None |
EDURANT 27.5mg/1  |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIRENZ 200 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in AL cover EFAVIRENZ 200 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIRENZ 50 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in AL cover EFAVIRENZ 50 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
EFAVIRENZ 600 MG TABLET [Sustiva] ![Compare how all Medicare Part D PDP plans in AL cover EFAVIRENZ 600 MG TABLET [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
ELIQUIS 2.5 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ELIQUIS 5 MG STARTER PACK  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ELIQUIS 5 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EMCYT 140MG CAPSULE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
EMEND 125 MG POWDER PACKET  |
4 |
Non-Preferred Drug |
42% | 42% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMGALITY 120 MG/ML PEN INJCTR  |
3 |
Preferred Brand |
$37.00 | $92.50 | P Q:2 /30Days |
EMGALITY 120 MG/ML SYRINGE  |
3 |
Preferred Brand |
$37.00 | $92.50 | P Q:2 /30Days |
EMOQUETTE 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in AL cover EMOQUETTE 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy] ![Compare how all Medicare Part D PDP plans in AL cover Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:120 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
EMTRIVA 10MG/ML SOLUTION  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EMTRIVA 200MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EMVERM 100 MG TABLET CHEW  |
5 |
Specialty Tier |
25% | N/A | None |
ENALAPRIL MALEATE 10 MG TAB  |
2 |
Generic |
$1.00 | $2.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENALAPRIL MALEATE 2.5 MG TAB  |
2 |
Generic |
$1.00 | $2.50 | None |
ENALAPRIL MALEATE 20 MG TAB  |
2 |
Generic |
$1.00 | $2.50 | None |
ENALAPRIL MALEATE 5 MG TABLET  |
2 |
Generic |
$1.00 | $2.50 | None |
Enalapril Maleate and Hydrochlorothiazide 10; 25mg/1; mg/1 100 TABLET BOTTLE, PLASTIC  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
ENALAPRIL-HCTZ 5-12.5 MG TAB  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
ENDARI 5 GRAM POWDER PACKET  |
5 |
Specialty Tier |
25% | N/A | P |
ENDOCET 10MG-325MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:180 /30Days |
ENDOCET 5/325 TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:360 /30Days |
ENDOCET 7.5-325MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | Q:240 /30Days |
ENGERIX B INJECTION  |
3 |
Preferred Brand |
$37.00 | $92.50 | P |
ENGERIX-B 20 MCG/ML SYRN  |
3 |
Preferred Brand |
$37.00 | $92.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENOXAPARIN 100 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 120 MG/0.8 ML SYRINGE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 150 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 30 MG/0.3 ML SYR  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 40 MG/0.4 ML SYR  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 60 MG/0.6 ML SYRINGE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENOXAPARIN 80 MG/0.8 ML SYRINGE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENSKYCE 28 TABLET [Solia] ![Compare how all Medicare Part D PDP plans in AL cover ENSKYCE 28 TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ENSTILAR 0.005%-0.064% FOAM  |
4 |
Non-Preferred Drug |
42% | 42% | P |
ENTACAPONE 200 MG TABLET [Comtan Entacapone] ![Compare how all Medicare Part D PDP plans in AL cover ENTACAPONE 200 MG TABLET [Comtan Entacapone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
ENTECAVIR 0.5 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in AL cover ENTECAVIR 0.5 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENTECAVIR 1 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in AL cover ENTECAVIR 1 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
ENTRESTO 24 MG-26 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ENTRESTO 49 MG-51 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ENTRESTO 97 MG-103 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ENULOSE 10 GM/15 ML SOLUTION  |
2 |
Generic |
$1.00 | $2.50 | None |
EPCLUSA 400 MG-100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
EPIDIOLEX 100 MG/ML SOLUTION  |
5 |
Specialty Tier |
25% | N/A | P Q:600 /30Days |
EPINEPHRINE 0.15 MG AUTO-INJECT  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EPINEPHRINE 0.3 MG AUTO-INJECT  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EPITOL 200MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
EPIVIR HBV 25MG/5ML TUBEX  |
4 |
Non-Preferred Drug |
42% | 42% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Eplerenone 25mg/1 90 TABLET BOTTLE  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Eplerenone 50mg/1 90 TABLET BOTTLE  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Ergotamine-caffeine 1-100mg tb  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERIVEDGE 150 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
ERLEADA 60 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
ERLOTINIB HCL 100 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in AL cover ERLOTINIB HCL 100 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLOTINIB HCL 150 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in AL cover ERLOTINIB HCL 150 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLOTINIB HCL 25 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in AL cover ERLOTINIB HCL 25 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
Errin 0.35 mg tablet  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ERTAPENEM 1 GRAM VIAL [Invanz] ![Compare how all Medicare Part D PDP plans in AL cover ERTAPENEM 1 GRAM VIAL [Invanz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERY-TAB TAB 250MG EC  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERY-TAB TAB 333MG EC  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROCIN 500MG ADDVNT VL  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROCIN TAB 250MG  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROMYCIN 0.5% EYE OINTMENT  |
2 |
Generic |
$1.00 | $2.50 | None |
ERYTHROMYCIN 2% GEL  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROMYCIN 2% SOLUTION  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ERYTHROMYCIN 500 MG FILMTAB  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROMYCIN EC 250 MG CAP  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROMYCIN ES 400 MG TAB  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ERYTHROMYCIN TAB 250MG BS  |
4 |
Non-Preferred Drug |
42% | 42% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESBRIET 267 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
ESBRIET 267 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
ESBRIET 801 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P |
ESCITALOPRAM 10 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in AL cover ESCITALOPRAM 10 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ESCITALOPRAM 20 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in AL cover ESCITALOPRAM 20 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ESCITALOPRAM 5 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in AL cover ESCITALOPRAM 5 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro] ![Compare how all Medicare Part D PDP plans in AL cover ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
ESOMEPRAZOLE MAG DR 20 MG CAP [Nexium] ![Compare how all Medicare Part D PDP plans in AL cover ESOMEPRAZOLE MAG DR 20 MG CAP [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium] ![Compare how all Medicare Part D PDP plans in AL cover ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |
ESTARYLLA 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in AL cover ESTARYLLA 0.25-0.035 MG TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL 0.01% CREAM  |
4 |
Non-Preferred Drug |
42% | 42% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 0.5 MG TABLET  |
2 |
Generic |
$1.00 | $2.50 | None |
ESTRADIOL 1 MG TABLET  |
2 |
Generic |
$1.00 | $2.50 | None |
ESTRADIOL 10 MCG VAGINAL INSRT  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL 2MG TABLET  |
2 |
Generic |
$1.00 | $2.50 | None |
ESTRADIOL TDS 0.025 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL TDS 0.0375 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL TDS 0.05 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL TDS 0.06 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL TDS 0.075 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL TDS 0.1 MG/DAY  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ESTRADIOL VALERATE 20mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL VALERATE 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ETHAMBUTOL HCL 400 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Ethambutol Hydrochloride 100mg/1  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
Ethinyl Estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv] ![Compare how all Medicare Part D PDP plans in AL cover Ethinyl Estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21  |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ETHOSUXIMIDE 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ETHOSUXIMIDE 250 MG/5 ML SOLN  |
4 |
Non-Preferred Drug |
42% | 42% | None |
ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA] ![Compare how all Medicare Part D PDP plans in AL cover ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ethynodiol-eth estra 1mg-50mcg [ZOVIA] ![Compare how all Medicare Part D PDP plans in AL cover ethynodiol-eth estra 1mg-50mcg [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $92.50 | None |
ETODOLAC 200 MG CAPSULE [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC 200 MG CAPSULE [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETODOLAC 300 MG CAPSULE [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC 300 MG CAPSULE [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ETODOLAC 400 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC 400 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ETODOLAC 500 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC 500 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ETODOLAC ER 400 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC ER 400 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ETODOLAC ER 500 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC ER 500 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
ETODOLAC ER 600 MG TABLET [LODINE] ![Compare how all Medicare Part D PDP plans in AL cover ETODOLAC ER 600 MG TABLET [LODINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $2.50 | None |
EVOTAZ 300 MG-150 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
EXEMESTANE 25 MG TABLET  |
4 |
Non-Preferred Drug |
42% | 42% | None |
EZETIMIBE 10 MG TABLET [Zetia] ![Compare how all Medicare Part D PDP plans in AL cover EZETIMIBE 10 MG TABLET [Zetia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
42% | 42% | None |