2019 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-257-0)
Benefit Details
 |
The Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-257-0) Formulary Drugs Starting with the Letter T in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $57.90 Deductible: $100 Qualifies for LIS: No |
Drugs Starting with Letter T
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
TABLOID 40 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Tacrolimus 0.03% ointment  |
4 |
Non-Preferred Drug |
50% | 50% | Q:100 /90Days |
Tacrolimus 0.1% ointment  |
4 |
Non-Preferred Drug |
50% | 50% | Q:100 /90Days |
TACROLIMUS 0.5 MG CAPSULE  |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
TACROLIMUS 1 MG CAPSULE  |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
TACROLIMUS 5 MG CAPSULE  |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
TAFINLAR 50 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:120 /30Days |
TAFINLAR 75 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:120 /30Days |
TAGRISSO 40 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
TAGRISSO 80 MG TABLET  |
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 |
TALZENNA 0.25 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:90 /30Days |
TALZENNA 1 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:90 /30Days |
TAMOXIFEN 10 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TAMOXIFEN CITRATE 20MG TABLET (30 CT)  |
2* |
Generic |
$10.00 | $25.00 | None |
TAMSULOSIN HCL 0.4 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
TARCEVA 100MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
TARCEVA 150MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
TARCEVA 25MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
TARGRETIN 1% GEL  |
5 |
Specialty Tier |
31% | N/A | Q:60 /30Days |
Tarina Fe 1-20 tablet  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Tasigna 150mg/1 4 BLISTER PACK per CARTON / 28 CAPSULE per BLISTER PACK  |
5 |
Specialty Tier |
31% | N/A | P Q:112 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TASIGNA 200 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:112 /28Days |
TASIGNA 50 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:420 /30Days |
TAZAROTENE 0.1% CREAM [Tazorac] ![Compare how all Medicare Part D PDP plans in AL cover TAZAROTENE 0.1% CREAM [Tazorac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZICEF 1GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZICEF 2 GRAM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZICEF 6 GRAM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZORAC 0.05% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZORAC 0.05% GEL  |
4 |
Non-Preferred Drug |
50% | 50% | Q:100 /30Days |
TAZORAC 0.1% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TAZORAC 0.1% GEL  |
4 |
Non-Preferred Drug |
50% | 50% | Q:100 /30Days |
TAZTIA DILTIAZEM HYDROCHLORIDE 120MG ER CAPSULES  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TAZTIA XT 180 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
TAZTIA XT 240MG CAPSULE SA  |
2* |
Generic |
$10.00 | $25.00 | None |
TAZTIA XT 300 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
TECFIDERA DR 120 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:14 /30Days |
TECFIDERA DR 240 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
TECFIDERA STARTER PACK  |
5 |
Specialty Tier |
31% | N/A | P Q:120 /365Days |
Teflaro 400mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE  |
5 |
Specialty Tier |
31% | N/A | None |
Teflaro 600mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE  |
5 |
Specialty Tier |
31% | N/A | None |
TEKTURNA 150 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
TEKTURNA 300 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
TEKTURNA HCT 300-25 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TELMISARTAN 20 MG TABLET [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN 20 MG TABLET [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TELMISARTAN 40 MG TABLET [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN 40 MG TABLET [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TELMISARTAN 80 MG TABLET [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN 80 MG TABLET [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
Telmisartan-Amlodipine 40-10 MG [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover Telmisartan-Amlodipine 40-10 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
Telmisartan-Amlodipine 40-5 MG [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover Telmisartan-Amlodipine 40-5 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
Telmisartan-Amlodipine 80-10 MG [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover Telmisartan-Amlodipine 80-10 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
Telmisartan-Amlodipine 80-5 MG [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover Telmisartan-Amlodipine 80-5 MG [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TELMISARTAN-HCTZ 40-12.5 MG TB [Micardis] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN-HCTZ 40-12.5 MG TB [Micardis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TELMISARTAN-HCTZ 80-12.5 MG TAB [Micardis HCT] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN-HCTZ 80-12.5 MG TAB [Micardis HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
TELMISARTAN-HCTZ 80-25 MG TAB [Micardis HCT] ![Compare how all Medicare Part D PDP plans in AL cover TELMISARTAN-HCTZ 80-25 MG TAB [Micardis HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TEMAZEPAM 15 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | Q:60 /365Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TEMAZEPAM 22.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /365Days |
TEMAZEPAM 30 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | Q:60 /365Days |
Temazepam 7.5mg/1 100 CAPSULE BOTTLE, PLASTIC  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /365Days |
TENIVAC SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /28Days |
TENOFOVIR DISOP FUM 300 MG TABLET [Viread] ![Compare how all Medicare Part D PDP plans in AL cover TENOFOVIR DISOP FUM 300 MG TABLET [Viread].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TERAZOSIN 1 MG CAPSULE  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TERAZOSIN 10 MG CAPSULE [Hytrin] ![Compare how all Medicare Part D PDP plans in AL cover TERAZOSIN 10 MG CAPSULE [Hytrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $10.00 | Q:60 /30Days |
TERAZOSIN 2 MG CAPSULE  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TERAZOSIN 5 MG CAPSULE [Hytrin] ![Compare how all Medicare Part D PDP plans in AL cover TERAZOSIN 5 MG CAPSULE [Hytrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TERBINAFINE HCL 250 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | Q:90 /365Days |
TERBUTALINE SULFATE 2.5 MG TAB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TERBUTALINE SULFATE 5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TERCONAZOLE 0.4% CREAM WITH APPLICATOR  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TERCONAZOLE 0.8% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TERCONAZOLE 80MG SUPPOSITORY VAGINAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TESTOSTERONE 12.5 MG/1.25 GRAM  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:300 /30Days |
Testosterone 2500 MG 0.01 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:300 /30Days |
Testosterone 5000 MG 0.01 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:300 /30Days |
Testosterone cyp 100 mg/ml  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TESTOSTERONE CYP 200 MG/ML  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TESTOSTERONE ENANTHATE 200MG/ML INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | Q:5 /30Days |
TETRABENAZINE 12.5 MG TABLET [XENAZINE] ![Compare how all Medicare Part D PDP plans in AL cover TETRABENAZINE 12.5 MG TABLET [XENAZINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TETRABENAZINE 25 MG TABLET [XENAZINE] ![Compare how all Medicare Part D PDP plans in AL cover TETRABENAZINE 25 MG TABLET [XENAZINE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:120 /30Days |
TETRACYCLINE 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TETRACYCLINE 500 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TEXACORT 2.5% SOLUTION  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
THALOMID 100 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:28 /28Days |
THALOMID 150 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:28 /28Days |
THALOMID 200 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:56 /28Days |
THALOMID 50 MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | P Q:28 /28Days |
THEO-24 ER 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THEO-24 ER 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THEO-24 ER 300 MG 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 |
THEO-24 ER 400 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THEOPHYLLINE ER 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
THEOPHYLLINE ER 200 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
THEOPHYLLINE ER 300 MG TAB  |
2* |
Generic |
$10.00 | $25.00 | None |
THEOPHYLLINE ER 400 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
THEOPHYLLINE ER 600 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
THIORIDAZINE 10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIORIDAZINE 100MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIORIDAZINE 25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIORIDAZINE 50 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIOTHIXENE 1 MG 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 |
THIOTHIXENE 10MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIOTHIXENE 2MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THIOTHIXENE 5MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
THYROLAR-1 TABLETS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
THYROLAR-1/2 TABLETS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
THYROLAR-1/4 TABLETS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
THYROLAR-2 TABLETS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
THYROLAR-3 TABLETS  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
TIAGABINE HCL 12 MG TABLET [Gabitril] ![Compare how all Medicare Part D PDP plans in AL cover TIAGABINE HCL 12 MG TABLET [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S |
TIAGABINE HCL 16 MG TABLET [Gabitril] ![Compare how all Medicare Part D PDP plans in AL cover TIAGABINE HCL 16 MG TABLET [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S |
tiagabine hcl 2 mg tablet [Gabitril] ![Compare how all Medicare Part D PDP plans in AL cover tiagabine hcl 2 mg tablet [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
tiagabine hcl 4 mg tablet [Gabitril] ![Compare how all Medicare Part D PDP plans in AL cover tiagabine hcl 4 mg tablet [Gabitril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S |
TIBSOVO 250 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
TIGECYCLINE 50 MG VIAL [Tygacil] ![Compare how all Medicare Part D PDP plans in AL cover TIGECYCLINE 50 MG VIAL [Tygacil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
TIMOLOL 0.25% EYE DROPS  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TIMOLOL 0.25% GFS GEL-SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TIMOLOL 0.5% EYE DROPS  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TIMOLOL 0.5% GFS GEL-SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TIMOLOL MALEATE 10MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TIMOLOL MALEATE 20MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TIMOLOL MALEATE 5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TIVICAY 10 MG TABLET  |
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 |
TIVICAY 25 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:60 /30Days |
TIVICAY 50 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:60 /30Days |
TIZANIDINE HCL 2 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TIZANIDINE HCL 4 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TOBI PODHALER 28 MG INHALE CAP  |
5 |
Specialty Tier |
31% | N/A | Q:1568 /365Days |
TOBRADEX EYE OINTMENT  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
TOBRAMYCIN 0.3% EYE DROPS [Tobrex] ![Compare how all Medicare Part D PDP plans in AL cover TOBRAMYCIN 0.3% EYE DROPS [Tobrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
TOBRAMYCIN 10 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in AL cover TOBRAMYCIN 10 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
TOBRAMYCIN 300 MG/5 ML AMPULE [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in AL cover TOBRAMYCIN 300 MG/5 ML AMPULE [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P |
TOBRAMYCIN 40 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate] ![Compare how all Medicare Part D PDP plans in AL cover TOBRAMYCIN 40 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
TOBRAMYCIN-DEXAMETH OPTH SUSP  |
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 |
TOLAK 4% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TOLTERODINE TARTRATE 1 MG TAB [Detrol LA] ![Compare how all Medicare Part D PDP plans in AL cover TOLTERODINE TARTRATE 1 MG TAB [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
TOLTERODINE TARTRATE 2 MG TABLET [Detrol] ![Compare how all Medicare Part D PDP plans in AL cover TOLTERODINE TARTRATE 2 MG TABLET [Detrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
Tolterodine Tartrate 24 HR 4 MG Extended Release Oral Capsule [Detrol LA] ![Compare how all Medicare Part D PDP plans in AL cover Tolterodine Tartrate 24 HR 4 MG Extended Release Oral Capsule [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
Tolterodine Tartrate ER 2 MG CAPSULE [Detrol LA] ![Compare how all Medicare Part D PDP plans in AL cover Tolterodine Tartrate ER 2 MG CAPSULE [Detrol LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
TOLVAPTAN 15 MG ORAL TABLET [SAMSCA] ![Compare how all Medicare Part D PDP plans in AL cover TOLVAPTAN 15 MG ORAL TABLET [SAMSCA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:30 /30Days |
TOLVAPTAN 30 MG ORAL TABLET [SAMSCA] ![Compare how all Medicare Part D PDP plans in AL cover TOLVAPTAN 30 MG ORAL TABLET [SAMSCA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
TOPIRAMATE 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TOPIRAMATE 15 MG SPRINKLE CAP  |
2* |
Generic |
$10.00 | $25.00 | None |
TOPIRAMATE 200 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TOPIRAMATE 25 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 |
Topiramate 25mg/1  |
2* |
Generic |
$10.00 | $25.00 | None |
TOPIRAMATE 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TOREMIFENE CITRATE 60 MG TABLET [Fareston] ![Compare how all Medicare Part D PDP plans in AL cover TOREMIFENE CITRATE 60 MG TABLET [Fareston].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TORSEMIDE 10 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TORSEMIDE 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TORSEMIDE 20 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TORSEMIDE 5 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TOUJEO MAX SOLOSTAR 300UNIT/ML INSULN PEN  |
6* |
Select Care Drugs |
$6.00 | $15.00 | None |
TOUJEO SOLOSTAR 300 UNITS/ML  |
6* |
Select Care Drugs |
$6.00 | $15.00 | None |
TPN ELECTROLYTES16.5/25.4 VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRACLEER 125MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRACLEER 32 MG TABLET FOR SUSP  |
5 |
Specialty Tier |
31% | N/A | P |
TRACLEER 62.5MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:60 /30Days |
TRADJENTA 5 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
TRAMADOL HCL 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | Q:240 /30Days |
TRAMADOL-ACETAMINOPHN 37.5-325  |
4 |
Non-Preferred Drug |
50% | 50% | Q:240 /30Days |
TRANDOLAPRIL 1 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | Q:30 /30Days |
TRANDOLAPRIL 2 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
TRANDOLAPRIL 4 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days |
tranexamic acid 650 mg tablet  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /28Days |
TRANSDERM-SCOP 1.5 MG/3 DAY  |
4 |
Non-Preferred Drug |
50% | 50% | Q:10 /30Days |
TRANYLCYPROMINE SULF 10 MG TABLET [Parnate] ![Compare how all Medicare Part D PDP plans in AL cover TRANYLCYPROMINE SULF 10 MG TABLET [Parnate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRAVASOL 10% SOLUTION VIAFLEX  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRAVATAN Z 0.04MG DROPS 2.5ML BOT  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:5 /30Days |
TRAZODONE 100 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRAZODONE 300 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TRAZODONE 50 MG TABLET  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRAZODONE HCL TABLET USP 150MG (100 CT)  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRECATOR 250MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
TRELEGY ELLIPTA 100-62.5-25  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
TRELSTAR 11.25 MG SYRINGE  |
5 |
Specialty Tier |
31% | N/A | P Q:1 /84Days |
TRELSTAR 3.75 MG SYRINGE  |
5 |
Specialty Tier |
31% | N/A | P Q:1 /28Days |
TRESIBA 100 UNIT/ML VIAL  |
6* |
Select Care Drugs |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRESIBA FLEXTOUCH 100 UNITS/ML  |
6* |
Select Care Drugs |
$6.00 | $15.00 | None |
TRESIBA FLEXTOUCH 200 UNITS/ML  |
6* |
Select Care Drugs |
$6.00 | $15.00 | None |
Tretinoin 0.0004 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Tretinoin 0.001 MG/MG Topical Gel  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRETINOIN 0.01% GEL  |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:45 /30Days |
TRETINOIN 0.025% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
TRETINOIN 0.025% GEL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRETINOIN 0.05% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
TRETINOIN 0.05% GEL [Atralin] ![Compare how all Medicare Part D PDP plans in AL cover TRETINOIN 0.05% GEL [Atralin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
TRETINOIN 0.1% CREAM  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
TRETINOIN 10MG CAPSULE  |
5 |
Specialty Tier |
31% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRI-ESTARYLLA TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in AL cover TRI-ESTARYLLA TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
TRI-LEGEST FE 5-7-9-7 TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
TRI-MILI 28 TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in AL cover TRI-MILI 28 TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
TRI-PREVIFEM TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in AL cover TRI-PREVIFEM TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
TRI-SPRINTEC 7DAYSX3 28 TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TRI-VYLIBRA 28 TABLET [Trinessa] ![Compare how all Medicare Part D PDP plans in AL cover TRI-VYLIBRA 28 TABLET [Trinessa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMCINOLONE 0.025% CREAM  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMCINOLONE 0.025% LOTION  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMCINOLONE 0.025% OINT  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMCINOLONE 0.1% CREAM  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRIAMCINOLONE 0.1% LOTION [Kenalog] ![Compare how all Medicare Part D PDP plans in AL cover TRIAMCINOLONE 0.1% LOTION [Kenalog].](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 |
TRIAMCINOLONE 0.1% OINTMENT  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMCINOLONE 0.1% PASTE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE  |
2* |
Generic |
$10.00 | $25.00 | None |
Triamcinolone Acetonide 1 MG/ML Topical Cream [Triderm] ![Compare how all Medicare Part D PDP plans in AL cover Triamcinolone Acetonide 1 MG/ML Topical Cream [Triderm].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
Triamcinolone Acetonide 5mg/g 1 TUBE per CARTON / 15 g in 1 TUBE  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIAMTERENE-HCTZ 37.5-25 MG CP  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRIAMTERENE-HCTZ 37.5-25 MG TB  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRIAMTERENE-HCTZ 75-50 MG TAB  |
1* |
Preferred Generic |
$4.00 | $10.00 | None |
TRIENTINE HCL 250 MG CAPSULE [Syprine] ![Compare how all Medicare Part D PDP plans in AL cover TRIENTINE HCL 250 MG CAPSULE [Syprine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
TRIFLUOPERAZINE 1 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRIFLUOPERAZINE HCL 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 |
TRIFLUOPERAZINE HCL 5MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML BOT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRIHEXYPHENIDYL 2 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | P |
TRIHEXYPHENIDYL 5 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | P |
Trihexyphenidyl Hydrochloride 2mg/5mL 473 mL in 1 BOTTLE  |
2* |
Generic |
$10.00 | $25.00 | P |
TRILYTE WITH FLAVOR PACKETS  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIMETHOPRIM 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TRIMIPRAMINE MALEATE 100 MG CP  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRIMIPRAMINE MALEATE 25 MG CAP  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRIMIPRAMINE MALEATE 50 MG CAP  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRINTELLIX 10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
TRINTELLIX 20 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
TRINTELLIX 5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | S Q:30 /30Days |
Triptorelin 11.3 MG/ML Injectable Suspension [Trelstar] ![Compare how all Medicare Part D PDP plans in AL cover Triptorelin 11.3 MG/ML Injectable Suspension [Trelstar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P Q:1 /168Days |
TRIUMEQ TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TRIVORA-28 TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TROPHAMINE INJECTION SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TROPHAMINE INJECTION SOLUTION 6%  |
4 |
Non-Preferred Drug |
50% | 50% | P |
TRULANCE 3 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
TRULICITY 0.75 MG/0.5 ML PEN  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:2 /28Days |
TRULICITY 1.5 MG/0.5 ML PEN  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
TRUMENBA 120 MCG/0.5 ML VACCIN Syringe  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TRUVADA 100 MG-150 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TRUVADA 133 MG-200 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TRUVADA 167 MG-250 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TRUVADA 200/300MG TABLET  |
5 |
Specialty Tier |
31% | N/A | Q:30 /30Days |
TWINRIX VACCINE SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TYBOST 150 MG TABLET  |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
TYDEMY TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
TYKERB 250 MG TABLET  |
5 |
Specialty Tier |
31% | N/A | P Q:180 /30Days |
TYPHIM VI 25 MCG/0.5 ML SYRINGE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
TYPHIM VI 25MCG/0.5ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |