2019 Medicare Part D Plan Formulary Information |
Solis Health Plans (HMO) (H0982-001-0)
Benefit Details
|
The Solis Health Plans (HMO) (H0982-001-0) Formulary Drugs Starting with the Letter Z in Miami-Dade County, FL: CMS MA Region 9 which includes: FL Plan Monthly Premium: $0.00 Deductible: $0 |
Drugs Starting with Letter Z
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ZAFIRLUKAST 10MG TABLETS |
2 |
Generic |
$0.00 | $0.00 | None |
ZAFIRLUKAST 20MG TABLETS |
2 |
Generic |
$0.00 | $0.00 | None |
ZALEPLON 10 MG CAPSULE |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ZALEPLON 5 MG CAPSULE |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ZANAFLEX 2 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZANAFLEX 4 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZANAFLEX 4 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZANAFLEX 6 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZARAH TABLET |
2 |
Generic |
$0.00 | $0.00 | None |
ZARONTIN 250 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZARONTIN 250 MG/5ML SYRUP |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZARXIO 300 MCG/0.5 ML SYRINGE |
5 |
Specialty Tier |
33% | 33% | None |
ZARXIO 480 MCG/0.8 ML SYRINGE |
5 |
Specialty Tier |
33% | 33% | None |
ZEJULA 100 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:90 /30Days |
ZELAPAR 1.25MG ODT TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZELBORAF 240 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:240 /30Days |
ZEMAIRA 1000MG VIAL |
5 |
Specialty Tier |
33% | 33% | None |
ZENATANE 10 MG CAPSULE |
2 |
Generic |
$0.00 | $0.00 | None |
ZENATANE 20 MG CAPSULE |
2 |
Generic |
$0.00 | $0.00 | None |
ZENATANE 30 MG CAPSULE |
2 |
Generic |
$0.00 | $0.00 | None |
ZENATANE 40 MG CAPSULE |
2 |
Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZENPEP DR 10,000 UNIT CAPSULE DR |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 15,000 UNIT CAPSULE DR |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 20,000 UNIT CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 25,000 UNIT CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 3,000 UNIT CAPSULE DR |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 40,000 UNIT CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZENPEP DR 5,000 UNIT CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZERBAXA 1-0.5 GRAM VIAL |
5 |
Specialty Tier |
33% | 33% | None |
ZESTORETIC 10-12.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTORETIC 20-12.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTORETIC 20-25 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZESTRIL 10 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTRIL 2.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTRIL 20 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTRIL 30 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTRIL 40 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZESTRIL 5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZETIA 10 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days |
ZIAC 10-6.25 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZIAC 2.5-6.25MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZIAC 5-6.25 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZIAGEN 20mg/mL 240 mL in 1 BOTTLE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZIAGEN 300mg/1 60 FILM COATED TABLETS in BOTTLE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZIANA 1.2-0.025% GEL TOPICAL |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZIDOVUDINE 100MG CAPSULE |
2 |
Generic |
$0.00 | $0.00 | None |
ZIDOVUDINE 10MG/ML SYRUP |
2 |
Generic |
$0.00 | $0.00 | None |
Zidovudine 300mg/1 12 BOTTLE CASE / 60 TABLET BOTTLE |
2 |
Generic |
$0.00 | $0.00 | None |
ZILEUTON ER 600 MG TABLET TBMP 12HR [Zyflo CR] |
2 |
Generic |
$0.00 | $0.00 | None |
ZIOPTAN 0.0015% EYE DROPS |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S Q:30 /30Days |
ZIPRASIDONE HCL 20 MG CAPSULE [Geodon] |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ZIPRASIDONE HCL 40 MG CAPSULE [Geodon] |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ZIPRASIDONE HCL 60 MG CAPSULE [Geodon] |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ZIPRASIDONE HCL 80 MG CAPSULE [Geodon] |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZIRGAN 1.5mg/g 1 TUBE, WITH APPLICATOR per CARTON / 5 g in 1 TUBE, WITH APPLICATOR |
3 |
Preferred Brand |
$10.00 | $20.00 | None |
ZITHROMAX 1g/1 3 POWDER, FOR SUSPENSION in 1 BOX |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX 200 MG/5 ML SUSP |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX 250MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX 250MG Z-PAK TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX 500MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX IV 500MG VIAL 10 VIAL BOX |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX ORAL SUSP 100MG/5ML |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZITHROMAX TRI-PAK 500MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOCOR 10 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZOCOR 20 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZOCOR 40 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZOCOR 80 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | S |
ZOFRAN 8 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
ZOLINZA 100MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P |
ZOLMITRIPTAN 2.5 MG ODT [Zomig, Zomig-ZMT] |
2 |
Generic |
$0.00 | $0.00 | Q:18 /30Days |
ZOLMITRIPTAN 2.5 MG TABLET [Zomig, Zomig-ZMT] |
2 |
Generic |
$0.00 | $0.00 | Q:18 /30Days |
ZOLMITRIPTAN 5 MG ODT [Zomig, Zomig-ZMT] |
2 |
Generic |
$0.00 | $0.00 | Q:18 /30Days |
ZOLMITRIPTAN 5 MG TABLET [Zomig, Zomig-ZMT] |
2 |
Generic |
$0.00 | $0.00 | Q:18 /30Days |
ZOLOFT 100 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOLOFT 25MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOLOFT 50 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZOLPIDEM TARTRATE 10 MG TABLET [Ambien, Edluar, Zolpimist] |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
ZOLPIDEM TARTRATE 5mg/1 100 FILM COATED TABLETS in BOTTLE [Ambien, Edluar, Zolpimist] |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
ZOMIG 2.5 MG NASAL SPRAY |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:16 /30Days |
ZOMIG 2.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:18 /30Days |
ZOMIG 5 MG NASAL SPRAY |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:12 /30Days |
ZOMIG 5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:18 /30Days |
ZOMIG ZMT 2.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:18 /30Days |
ZOMIG ZMT 5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | Q:18 /30Days |
ZONEGRAN 100 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZONEGRAN 25 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZONISAMIDE 100 MG CAPSULE |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZONISAMIDE 25 MG CAPSULE |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ZONISAMIDE 50 MG CAPSULE |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ZONTIVITY 2.08 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
ZORTRESS 0.25MG TABLETS |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
Zortress 0.5mg/1 60 BLISTER PACK in 1 BOX / 1 TABLET per BLISTER PACK |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
Zortress 0.75mg/1 60 BLISTER PACK in 1 BOX / 1 TABLET per BLISTER PACK |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
ZORTRESS 1 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | P |
ZOSTAVAX VIAL |
3 |
Preferred Brand |
$10.00 | $20.00 | None |
ZOSYN 2/0.25GM PRE-MIX BAG |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOSYN 3.375 GRAM VIAL |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOSYN 3/0.375GRAM 24 BAGS PKG |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZOVIA 1-35E TABLET |
2 |
Generic |
$0.00 | $0.00 | None |
ZOVIRAX 200 MG CAPSULE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOVIRAX 200 MG/5 ML Oral Suspension |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOVIRAX 5% CREAM |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOVIRAX 5% OINTMENT |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZOVIRAX 800 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZUBSOLV 1.4-0.36 MG TABLET SL |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:90 /30Days |
ZUBSOLV 11.4-2.9 MG TABLET SL |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:60 /30Days |
ZUBSOLV 2.9-0.71 MG TABLET SL |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:90 /30Days |
ZUBSOLV 5.7-1.4 MG TABLET SL |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:90 /30Days |
ZUBSOLV 8.6-2.1 MG TABLET SL |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZYBAN 150mg/1 60 FILM COATED TABLETS in BOTTLE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYCLARA 2.5% CREAM PUMP |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYCLARA 3.75% CREAM PUMP |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYDELIG 100 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
ZYDELIG 150 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
ZYFLO 600 MG FILMTAB (120 TABLETS) |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYFLO CR 600 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYKADIA 150 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:150 /30Days |
ZYKADIA 150 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:150 /30Days |
ZYLET EYE DROPS |
3 |
Preferred Brand |
$10.00 | $20.00 | None |
ZYLOPRIM 100 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZYLOPRIM 300 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYMAXID 5mg/mL 1 BOTTLE, DROPPER per CARTON / 2.5 mL in 1 BOTTLE, DROPPER |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 10 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 10MG VIAL |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 15 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 2.5MG 30 TABLET BOTTLE |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 20MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 5MG TABLET (30 BOT) |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA 7.5 MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA Relprevv 1 KIT in 1 CARTON |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA ZYDIS 10MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ZYPREXA ZYDIS 15MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA ZYDIS 20MG TABLET |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYPREXA ZYDIS 5MG TABLET (30 BLPK) |
4 |
Non-Preferred Brand |
$30.00 | $75.00 | None |
ZYTIGA 500 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
ZYVOX 100MG/5ML SUSPENSION |
5 |
Specialty Tier |
33% | 33% | P |
ZYVOX 600 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P |
ZYVOX 600MG/300ML IV SOLUTION |
5 |
Specialty Tier |
33% | 33% | P |