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2019 Medicare Part D and Medicare Advantage Plan Formulary Browser

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State & Plan   ZIP & Plan   PlanID   FormularyID

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PDP     MAPD
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Humana Enhanced (PDP) (S5884-001-0)
Tier 1 (206)
Tier 2 (606)
Tier 3 (711)
Tier 4 (1175)
Tier 5 (593)
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
Humana Enhanced (PDP) (S5884-001-0)
Benefits & Contact Info           
The Humana Enhanced (PDP) (S5884-001-0)
Formulary Drugs Starting with the Letter F

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $76.40 Deductible: $0 Qualifies for LIS: No
Drugs Starting with Letter F

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
FALMINA-28 TABLET   4 Non-Preferred Drug 50%44%None
FAMCICLOVIR 125 MG TABLET   3 Preferred Brand $47.00$116.00Q:90
/30Days
FAMCICLOVIR 250 MG TABLET   3 Preferred Brand $47.00$116.00Q:90
/30Days
FAMCICLOVIR 500 MG TABLET   3 Preferred Brand $47.00$116.00Q:90
/30Days
FAMOTIDINE 20 MG TABLET   2 Generic $10.00$0.00None
FAMOTIDINE 40 MG TABLET   2 Generic $10.00$0.00None
FAMOTIDINE 50 MG/5MLFOR ORAL SUSPENSION   4 Non-Preferred Drug 50%44%None
FANAPT 1 MG TABLET   4 Non-Preferred Drug 50%44%P Q:60
/30Days
FANAPT 10 MG TABLET   5 Specialty Tier 33%N/AP Q:60
/30Days
FANAPT 12 MG TABLET   5 Specialty Tier 33%N/AP Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FANAPT 2 MG TABLET   4 Non-Preferred Drug 50%44%P Q:60
/30Days
FANAPT 4 MG TABLET   4 Non-Preferred Drug 50%44%P Q:60
/30Days
FANAPT 6 MG TABLET   5 Specialty Tier 33%N/AP Q:60
/30Days
FANAPT 8 MG TABLET   5 Specialty Tier 33%N/AP Q:60
/30Days
FANAPT TITR TABLETS   4 Non-Preferred Drug 50%44%P Q:60
/30Days
FARESTON 60 MG TABLET   5 Specialty Tier 33%N/AQ:30
/30Days
FARXIGA 10 MG TABLET   4 Non-Preferred Drug 50%44%Q:30
/30Days
FARXIGA 5 MG TABLET   4 Non-Preferred Drug 50%44%Q:30
/30Days
FARYDAK 10 MG CAPSULE   5 Specialty Tier 33%N/AP Q:6
/21Days
FARYDAK 15 MG CAPSULE   5 Specialty Tier 33%N/AP Q:6
/21Days
FARYDAK 20 MG CAPSULE   5 Specialty Tier 33%N/AP Q:6
/21Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FAYOSIM TABLET TBDSPK 3MO [Quartette]   4 Non-Preferred Drug 50%44%Q:91
/90Days
FELBAMATE 400 MG TABLET   4 Non-Preferred Drug 50%44%None
FELBAMATE 600 MG TABLET   4 Non-Preferred Drug 50%44%None
FELBAMATE 600 MG/5 ML SUSP   5 Specialty Tier 33%N/ANone
FELODIPINE ER 10 MG TABLET   3 Preferred Brand $47.00$116.00Q:30
/30Days
FELODIPINE ER 2.5 MG TABLET   3 Preferred Brand $47.00$116.00Q:30
/30Days
FELODIPINE ER 5 MG TABLET   3 Preferred Brand $47.00$116.00Q:30
/30Days
FEMRING 0.05 MG/DAY VAG RING   4 Non-Preferred Drug 50%44%Q:1
/90Days
FEMRING 0.10 MG/DAY VAG RING   4 Non-Preferred Drug 50%44%Q:1
/90Days
Femynor 28 tablet   4 Non-Preferred Drug 50%44%None
FENOFIBRATE 134MG CAPSULE [LIPOFEN]   3 Preferred Brand $47.00$116.00Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENOFIBRATE 145 MG TABLET [LIPOFEN]   3 Preferred Brand $47.00$116.00Q:30
/30Days
FENOFIBRATE 160 MG TABLET [LIPOFEN]   2 Generic $10.00$0.00Q:30
/30Days
FENOFIBRATE 200 MG CAPSULE [LIPOFEN]   3 Preferred Brand $47.00$116.00Q:30
/30Days
FENOFIBRATE 48 MG TABLET [Tricor]   3 Preferred Brand $47.00$116.00Q:60
/30Days
FENOFIBRATE 54 MG 90 TABLET BOTTLE [LIPOFEN]   2 Generic $10.00$0.00Q:60
/30Days
FENOFIBRATE 67MG CAPSULE [LIPOFEN]   3 Preferred Brand $47.00$116.00Q:60
/30Days
FENTANYL 100 MCG/HR PATCH TD72 [Duragesic]   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 12 MCG/HR PATCH TD72 [Duragesic]   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 25 MCG/HR PATCH TD72 [Duragesic]   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 37.5 MCG/HR PATCH TD72   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 50 MCG/HR PATCH TD72 [Duragesic]   4 Non-Preferred Drug 50%44%Q:20
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENTANYL 62.5 MCG/HR PATCH TD72   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 75 MCG/HR PATCH TD72 [Duragesic]   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL 87.5 MCG/HR PATCH TD72   4 Non-Preferred Drug 50%44%Q:20
/30Days
FENTANYL CITRATE OTFC 1,200 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FENTANYL CITRATE OTFC 1,600 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FENTANYL CITRATE OTFC 200 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FENTANYL CITRATE OTFC 400 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FENTANYL CITRATE OTFC 600 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FENTANYL CITRATE OTFC 800 MCG [Actiq]   5 Specialty Tier 33%N/AP Q:120
/30Days
FETZIMA 20-40 MG TITRATION PAK   4 Non-Preferred Drug 50%44%P Q:28
/28Days
FETZIMA ER 120 MG CAPSULE   4 Non-Preferred Drug 50%44%P Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FETZIMA ER 20 MG CAPSULE   4 Non-Preferred Drug 50%44%P Q:30
/30Days
FETZIMA ER 40 MG CAPSULE   4 Non-Preferred Drug 50%44%P Q:30
/30Days
FETZIMA ER 80 MG CAPSULE   4 Non-Preferred Drug 50%44%P Q:30
/30Days
FIASP 100 UNIT/ML FLEXTOUCH INSULN PEN   3 Preferred Brand $47.00$116.00None
FIASP 100 UNIT/ML VIAL   3 Preferred Brand $47.00$116.00None
FINASTERIDE 5 MG TABLET   2 Generic $10.00$0.00Q:30
/30Days
FIRAZYR 30 MG/3 ML SYRINGE   5 Specialty Tier 33%N/AP Q:9
/30Days
FIRDAPSE 10 MG TABLET   5 Specialty Tier 33%N/AP Q:240
/30Days
FIRMAGON 2 X 120 MG KIT   5 Specialty Tier 33%N/AP
FIRMAGON 80 MG KIT   4 Non-Preferred Drug 50%44%P
FLAVOXATE 100 MG TAB 100   3 Preferred Brand $47.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLECAINIDE ACETATE 100 MG TAB   3 Preferred Brand $47.00$116.00None
FLECAINIDE ACETATE 150 MG TAB   3 Preferred Brand $47.00$116.00None
FLECAINIDE ACETATE 50 MG TAB   3 Preferred Brand $47.00$116.00None
FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLOVENT DISKUS POWDER 50MCG 60 CTR   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $47.00$116.00Q:24
/30Days
FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $47.00$116.00Q:24
/30Days
FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $47.00$116.00Q:11
/30Days
FLUCONAZOLE 10 MG/ML SUSP   3 Preferred Brand $47.00$116.00None
FLUCONAZOLE 100 MG TABLET   2 Generic $10.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUCONAZOLE 150 MG TABLET   2 Generic $10.00$0.00None
FLUCONAZOLE 200 MG TABLET   2 Generic $10.00$0.00None
FLUCONAZOLE 40 MG/ML SUSP   3 Preferred Brand $47.00$116.00None
Fluconazole 50mg/1 30 TABLET BOTTLE   2 Generic $10.00$0.00None
FLUCONAZOLE-NACL 200 MG/100 ML   4 Non-Preferred Drug 50%44%None
FLUCONAZOLE-NACL 400 MG/200 ML   4 Non-Preferred Drug 50%44%None
FLUCYTOSINE 250 MG CAPSULE [Ancobon]   5 Specialty Tier 33%N/ANone
FLUCYTOSINE 500 MG CAPSULE [Ancobon]   5 Specialty Tier 33%N/ANone
FLUDROCORTISONE 0.1 MG TABLET   2 Generic $10.00$0.00None
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL   3 Preferred Brand $47.00$116.00Q:50
/30Days
Fluocinolone 0.01% cream   4 Non-Preferred Drug 50%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUOCINOLONE 0.01% SCALP OIL   4 Non-Preferred Drug 50%44%None
FLUOCINOLONE 0.01% SOLUTION   4 Non-Preferred Drug 50%44%None
FLUOCINOLONE 0.025% CREAM (g) [Synalar]   4 Non-Preferred Drug 50%44%None
FLUOCINOLONE 0.025% OINTMENT   4 Non-Preferred Drug 50%44%None
FLUOCINONIDE 0.05% GEL   4 Non-Preferred Drug 50%44%None
FLUOCINONIDE 0.05% OINTMENT   3 Preferred Brand $47.00$116.00None
FLUOCINONIDE 0.05% SOLUTION   4 Non-Preferred Drug 50%44%None
FLUOCINONIDE-E 0.05% CREAM   4 Non-Preferred Drug 50%44%None
Fluorometholone 0.1% drops   3 Preferred Brand $47.00$116.00None
FLUOROURACIL 0.5% CREAM   5 Specialty Tier 33%N/ANone
FLUOROURACIL 2% TOPICAL SOLN   4 Non-Preferred Drug 50%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUOROURACIL 5% TOP SOLUTION   4 Non-Preferred Drug 50%44%None
FLUOROURACIL CREA 5%   4 Non-Preferred Drug 50%44%None
Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC   2 Generic $10.00$0.00None
FLUOXETINE CAPSULES 10MG (100 CT)   1 Preferred Generic $5.00$0.00Q:60
/30Days
FLUOXETINE DR 90 MG CAPSULE   4 Non-Preferred Drug 50%44%Q:4
/28Days
FLUOXETINE HCL 20 MG CAPSULE   1 Preferred Generic $5.00$0.00Q:120
/30Days
FLUOXETINE HCL 40 MG CAPSULE   1 Preferred Generic $5.00$0.00Q:60
/30Days
FLUPHENAZINE 1 MG TABLET   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE 10 MG TABLET   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE 2.5 MG TABLET   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE 2.5 MG/5 ML ELIX   4 Non-Preferred Drug 50%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUPHENAZINE 2.5MG/ML VIAL   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE 5 MG TABLET   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE 5MG/ML CONC   4 Non-Preferred Drug 50%44%None
FLUPHENAZINE DEC 125 MG/5 ML   4 Non-Preferred Drug 50%44%None
FLURBIPROFEN 0.03% EYE DROPS [Ocufen]   2 Generic $10.00$0.00None
Flurbiprofen 100mg/1 100 BOTTLE in 1 BOTTLE / 100 FILM COATED TABLETS in BOTTLE   2 Generic $10.00$0.00None
FLURBIPROFEN 50MG TABLET   2 Generic $10.00$0.00None
FLUTAMIDE 125 MG CAPSULE   4 Non-Preferred Drug 50%44%None
Fluticasone Propionate 0.05mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2 Generic $10.00$0.00None
Fluticasone Propionate 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2 Generic $10.00$0.00None
FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION   2 Generic $10.00$0.00Q:16
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUTICASONE-SALMETEROL 100-50 BLST W/DEV [Advair]   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLUTICASONE-SALMETEROL 113-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   3 Preferred Brand $47.00$116.00Q:1
/30Days
FLUTICASONE-SALMETEROL 232-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   3 Preferred Brand $47.00$116.00Q:1
/30Days
FLUTICASONE-SALMETEROL 250-50 BLST W/DEV [Advair]   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLUTICASONE-SALMETEROL 500-50 BLST W/DEV [Advair]   3 Preferred Brand $47.00$116.00Q:60
/30Days
FLUTICASONE-SALMETEROL 55-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   3 Preferred Brand $47.00$116.00Q:1
/30Days
FLUVOXAMINE MALEATE 100MG TABLET   2 Generic $10.00$0.00Q:90
/30Days
Fluvoxamine Maleate 25mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 100 FILM COATED TABLETS in   2 Generic $10.00$0.00Q:90
/30Days
Fluvoxamine maleate 50mg/1 100 FILM COATED TABLETS in BOTTLE   2 Generic $10.00$0.00Q:90
/30Days
Fondaparinux Sodium 10mg/0.8mL 2 SYRINGES per CARTON / 0.8 mL in 1 SYRINGE [Arixtra]   5 Specialty Tier 33%N/AQ:24
/30Days
Fondaparinux Sodium 2.5mg/0.5mL 2 SYRINGES per CARTON / 0.5 mL in 1 SYRINGE [Arixtra]   4 Non-Preferred Drug 50%44%Q:15
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Fondaparinux Sodium 5mg/4mL 2 SYRINGES per CARTON / 0.4 mL in 1 SYRINGE [Arixtra]   5 Specialty Tier 33%N/AQ:12
/30Days
Fondaparinux Sodium 7.5mg/0.6mL 2 SYRINGES per CARTON / 0.6 mL in 1 SYRINGE [Arixtra]   5 Specialty Tier 33%N/AQ:18
/30Days
Forteo 250ug/mL 1 SYRINGE per CARTON / 2.4 mL in 1 SYRINGE   4 Non-Preferred Drug 50%44%P Q:2
/28Days
FOSAMPRENAVIR 700 MG TABLET [Lexiva]   5 Specialty Tier 33%N/AQ:120
/30Days
FOSINOPRIL SODIUM 10 MG TAB   1 Preferred Generic $5.00$0.00None
FOSINOPRIL SODIUM 20 MG TAB   1 Preferred Generic $5.00$0.00None
FOSINOPRIL SODIUM 40 MG TAB   1 Preferred Generic $5.00$0.00None
FOSINOPRIL-HCTZ 10-12.5 MG TAB   2 Generic $10.00$0.00None
FOSINOPRIL-HCTZ 20-12.5 MG TAB   2 Generic $10.00$0.00None
FREAMINE HBC INJECTION   4 Non-Preferred Drug 50%44%P
FULPHILA 6 MG/0.6 ML SYRINGE   5 Specialty Tier 33%N/AP Q:1
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FUROSEMIDE 10 MG/ML SOLUTION   1 Preferred Generic $5.00$0.00None
Furosemide 10 ML 10 MG/ML Injection   4 Non-Preferred Drug 50%44%None
FUROSEMIDE 20 MG TABLET   1 Preferred Generic $5.00$0.00None
FUROSEMIDE 40 MG TABLET   1 Preferred Generic $5.00$0.00None
FUROSEMIDE 40MG/5ML TUBEX   1 Preferred Generic $5.00$0.00None
FUROSEMIDE 80 MG TABLET   1 Preferred Generic $5.00$0.00None
FUZEON 90 MG VIAL   5 Specialty Tier 33%N/AQ:60
/30Days
FYCOMPA 0.5 MG/ML ORAL SUSP   5 Specialty Tier 33%N/AP Q:680
/28Days
FYCOMPA 10 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
FYCOMPA 12 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
FYCOMPA 2 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FYCOMPA 4 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
FYCOMPA 6 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
FYCOMPA 8 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days

Chart Legend:

Below are a few notes to help you understand the above 2019 Medicare Part D Humana Enhanced (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.