2019 Medicare Part D Plan Formulary Information |
BlueRx Essential (PDP) (S1030-006-0)
Benefit Details
 |
The BlueRx Essential (PDP) (S1030-006-0) Formulary Drugs Starting with the Letter P in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $34.40 Deductible: $415 Qualifies for LIS: No |
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 200 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PACERONE 400MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PALIPERIDONE ER 1.5 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in AL cover PALIPERIDONE ER 1.5 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
PALIPERIDONE ER 3 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in AL cover PALIPERIDONE ER 3 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
PALIPERIDONE ER 6 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in AL cover PALIPERIDONE ER 6 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
PALIPERIDONE ER 9 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in AL cover PALIPERIDONE ER 9 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
PALYNZIQ 10 MG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
25% | 25% | P |
PALYNZIQ 2.5 MG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
25% | 25% | P |
PALYNZIQ 20 MG/ML SYRINGE  |
5 |
Specialty Tier |
25% | 25% | P |
PANRETIN 0.1% GEL 60GM TUBE  |
5 |
Specialty Tier |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PANTOPRAZOLE SOD DR 20 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | Q:30 /30Days |
PANTOPRAZOLE SOD DR 40 MG TAB  |
1 |
Preferred Generic |
$1.00 | $2.00 | Q:60 /30Days |
PARICALCITOL 1 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in AL cover PARICALCITOL 1 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PARICALCITOL 2 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in AL cover PARICALCITOL 2 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PARICALCITOL 4 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in AL cover PARICALCITOL 4 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PAROMOMYCIN 250 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PAROXETINE HCL 10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
PAROXETINE HCL 20 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
PAROXETINE HCL 30 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
PAROXETINE HCL 40 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:45 /30Days |
PASER GRANULES 4GM 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 |
PAXIL ORAL SUSPENSION 10 MG/5ML  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:900 /30Days |
PEDVAXHIB VACCINE VIAL  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PEG 3350 ELECTROLYTE SOLN SOLN RECON [GaviLyte-C] ![Compare how all Medicare Part D PDP plans in AL cover PEG 3350 ELECTROLYTE SOLN SOLN RECON [GaviLyte-C].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | None |
PEG 3350-ELECTROLYTE SOLUTION SOLN RECON  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PEG-3350 AND ELECTROLYTES SOLN SOLN RECON  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PEGANONE 250 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS  |
5 |
Specialty Tier |
25% | 25% | P |
PEGASYS INJECTION  |
5 |
Specialty Tier |
25% | 25% | P |
PEGASYS PROCLICK 180 MCG/0.5  |
5 |
Specialty Tier |
25% | 25% | P |
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENICILLIN GK 20 MILLION UNIT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID  |
2 |
Generic |
$4.00 | $8.00 | None |
PENICILLIN V POTASSIUM 500MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PENICILLIN VK 125 MG/5 ML SOLN  |
2 |
Generic |
$4.00 | $8.00 | None |
PENICILLIN VK 250 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PENTAM 300 INJ 300MG  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTOXIFYLLINE 400MG TABLET SA  |
2 |
Generic |
$4.00 | $8.00 | None |
Permethrin 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Perphenazine 16mg/1 100 FILM COATED TABLETS in BOTTLE  |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
PERPHENAZINE 4 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
PERPHENAZINE 8 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERPHENAZINE TABLETS USP 2MG 100 BOT  |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /30Days |
PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /30Days |
Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Phenobarbital 100mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Phenobarbital 15mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PHENOBARBITAL 16.2 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PHENOBARBITAL 20 MG/5 ML ELIX  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Phenobarbital 30mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PHENOBARBITAL 32.4 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Phenobarbital 60mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHENOBARBITAL 64.8 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PHENOBARBITAL 97.2 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PHENOXYBENZAMINE HCL 10 MG Capsule [Dibenzyline] ![Compare how all Medicare Part D PDP plans in AL cover PHENOXYBENZAMINE HCL 10 MG Capsule [Dibenzyline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Phenytoin 50 MG Chewable Tablet  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT  |
2 |
Generic |
$4.00 | $8.00 | None |
PHENYTOIN SOD EXT 100 MG CAP  |
2 |
Generic |
$4.00 | $8.00 | None |
PHENYTOIN SOD EXT 200 MG CAP  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PHENYTOIN SOD EXT 300 MG CAP  |
2 |
Generic |
$4.00 | $8.00 | None |
PHOSPHOLINE IODIDE 0.125% 6.25MG  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIFELTRO 100 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | Q:30 /30Days |
PILOCARPINE HCL 5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in AL cover PILOCARPINE HCL 5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PILOCARPINE HCL 7.5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in AL cover PILOCARPINE HCL 7.5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PIMECROLIMUS 1% CREAM (g) [Elidel] ![Compare how all Medicare Part D PDP plans in AL cover PIMECROLIMUS 1% CREAM (g) [Elidel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PIMOZIDE 1 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in AL cover PIMOZIDE 1 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PIMOZIDE 2 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in AL cover PIMOZIDE 2 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PIMTREA 28 DAY TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PINDOLOL 10 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PINDOLOL 5 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PIOGLITAZONE HCL 15 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in AL cover PIOGLITAZONE HCL 15 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | Q:90 /30Days |
PIOGLITAZONE HCL 30 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in AL cover PIOGLITAZONE HCL 30 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | Q:30 /30Days |
PIOGLITAZONE HCL 45 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in AL cover PIOGLITAZONE HCL 45 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | Q:30 /30Days |
PIPERACIL-TAZOBACT 2.25 GM VIAL  |
2 |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIPERACIL-TAZOBACT 3.375 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIPERACIL-TAZOBACT 4.5 GM VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Pirmella 1-35-28 tablet  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PLEGRIDY 125 MCG/0.5 ML PEN  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /28Days |
PLEGRIDY 125 MCG/0.5 ML SYRING  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /28Days |
PLEGRIDY PEN INJ STARTER PACK  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /28Days |
PLEGRIDY SYRINGE STARTER PACK  |
5 |
Specialty Tier |
25% | 25% | P Q:1 /28Days |
PODOFILOX 0.5% TOPICAL TUBEX  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
POLYMYXIN B-TMP EYE DROPS  |
2 |
Generic |
$4.00 | $8.00 | None |
POMALYST 1 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:21 /28Days |
POMALYST 2 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:21 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POMALYST 3 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:21 /28Days |
POMALYST 4 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:21 /28Days |
PORTIA 0.15-0.03 TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Potassium Chloride 2 MEQ/ML Injectable Solution  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Potassium Chloride 8 MEQ Extended Release Oral Tablet  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 10 MEQ TB  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
POTASSIUM CITRATE ER 15 MEQ TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 5 MEQ TAB  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL 10% (20 MEQ/15ML) Liquid [Kay Ciel] ![Compare how all Medicare Part D PDP plans in AL cover POTASSIUM CL 10% (20 MEQ/15ML) Liquid [Kay Ciel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 2 MEQ/ML VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in AL cover POTASSIUM CL 2 MEQ/ML VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
POTASSIUM CL ER 10 MEQ CAPSULE  |
2 |
Generic |
$4.00 | $8.00 | None |
POTASSIUM CL ER 10 MEQ TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
POTASSIUM CL ER 10 MEQ TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
POTASSIUM CL ER 20 MEQ TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
POTASSIUM CL ER 8 MEQ CAPSULE  |
2 |
Generic |
$4.00 | $8.00 | None |
PRADAXA 110 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:71 /90Days |
PRADAXA 150 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
PRADAXA 75 MG CAPSULE  |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
PRAMIPEXOLE 0.125 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAMIPEXOLE 0.25 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAMIPEXOLE 0.5 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAMIPEXOLE 0.75 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAMIPEXOLE 1 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAMIPEXOLE 1.5 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PRASUGREL 10 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PRASUGREL 5 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PRAVASTATIN SODIUM 10 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | Q:45 /30Days |
PRAVASTATIN SODIUM 20 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | Q:45 /30Days |
PRAVASTATIN SODIUM 40 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | Q:45 /30Days |
PRAVASTATIN SODIUM 80 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAZIQUANTEL 600 MG TABLET [Biltricide] ![Compare how all Medicare Part D PDP plans in AL cover PRAZIQUANTEL 600 MG TABLET [Biltricide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRAZOSIN 1 MG CAPSULE  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAZOSIN 2 MG CAPSULE  |
2 |
Generic |
$4.00 | $8.00 | None |
PRAZOSIN 5MG CAPSULE  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISOLONE 15 MG/5 ML SOLN  |
2 |
Generic |
$4.00 | $8.00 | None |
PREDNISOLONE AC 1% EYE DROP  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 1 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PREDNISONE 10 MG TAB DOSE PACK  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 10 MG TAB DOSE PACK  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 10 MG TABLET [Sterapred DS] ![Compare how all Medicare Part D PDP plans in AL cover PREDNISONE 10 MG TABLET [Sterapred DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 2.5 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Prednisone 20 MG Oral Tablet  |
1 |
Preferred Generic |
$1.00 | $2.00 | None |
PREDNISONE 5 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 5 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 5 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREDNISONE 5 MG/5 ML SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREDNISONE 50MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
Premarin 0.625mg/g  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREMASOL 6% IV SOLUTION  |
3 |
Preferred Brand |
$47.00 | $94.00 | P |
PREVALITE PACKET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREVIFEM TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in AL cover PREVIFEM TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PREVYMIS 240 MG  |
5 |
Specialty Tier |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREVYMIS 480 MG  |
5 |
Specialty Tier |
25% | 25% | None |
PREZCOBIX 800 MG-150 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | Q:30 /30Days |
PREZISTA 100 MG/ML SUSPENSION  |
5 |
Specialty Tier |
25% | 25% | Q:400 /30Days |
PREZISTA 150MG TABLETS  |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days |
PREZISTA 800 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | Q:30 /30Days |
PREZISTA TABLET 600MG  |
5 |
Specialty Tier |
25% | 25% | Q:60 /30Days |
PREZISTA TABLET 75MG  |
4 |
Non-Preferred Drug |
50% | 50% | Q:300 /30Days |
PRIFTIN 150 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Primaquine Phosphate 26.3 MG Oral Tablet  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PRIMIDONE 250 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in AL cover PRIMIDONE 250 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | None |
PRIMIDONE 50 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in AL cover PRIMIDONE 50 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROBENECID 500 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PROBENECID/COLCHICINE 0.5MG/500MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PROCHLORPERAZINE 10 MG TAB  |
2 |
Generic |
$4.00 | $8.00 | None |
PROCHLORPERAZINE 5 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROCRIT 10000U/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 3,000 UNITS/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 4,000 UNITS/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 40000U/ML VIAL PR  |
5 |
Specialty Tier |
25% | 25% | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCTO-MED HC 2.5% CREAM  |
2 |
Generic |
$4.00 | $8.00 | None |
procto-pak 1% cream  |
2 |
Generic |
$4.00 | $8.00 | None |
PROCTOSOL-HC 2.5% CREAM  |
2 |
Generic |
$4.00 | $8.00 | None |
PROCTOZONE-HC 2.5% CREAM  |
2 |
Generic |
$4.00 | $8.00 | None |
PROGESTERONE 100 MG CAPSULE  |
2 |
Generic |
$4.00 | $8.00 | None |
PROGESTERONE 200 MG CAPSULE [Prometrium] ![Compare how all Medicare Part D PDP plans in AL cover PROGESTERONE 200 MG CAPSULE [Prometrium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $8.00 | None |
PROGLYCEM 50 MG/ML ORAL SUSP  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PROGRAF 0.2 MG GRANULE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROGRAF 1 MG GRANULE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROLASTIN C 1,000 MG VIAL  |
5 |
Specialty Tier |
25% | 25% | P |
PROLIA 60MG/ML INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK  |
5 |
Specialty Tier |
25% | 25% | P |
PROMACTA 12.5 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
PROMACTA 25 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
PROMACTA 50 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
PROMACTA 75 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P |
PROMETHAZINE 25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain] ![Compare how all Medicare Part D PDP plans in AL cover PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROPAFENONE HCL 150 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPAFENONE HCL 225MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPAFENONE HCL 300 MG TAB  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PROPAFENONE HCL ER 225 MG CAP  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPRANOLOL 10 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPRANOLOL 20 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPRANOLOL 40 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPRANOLOL 80 MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROPYLTHIOURACIL 50MG TABLET  |
2 |
Generic |
$4.00 | $8.00 | None |
PROQUAD VIAL  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |
PROTRIPTYLINE HCL 10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROTRIPTYLINE HCL 5 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PULMOZYME 1MG/ML AMPUL  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PURIXAN 20 MG/ML ORAL SUSP  |
5 |
Specialty Tier |
25% | 25% | None |
PYRAZINAMIDE 500 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PYRIDOSTIGMINE BR 60 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $94.00 | None |