Q1GROUP LLC | Q1Medicare.com - a non-government resource for the Medicare community
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

SilverScript Allure (PDP) (S5601-153-0)
Tier 1 (119)
Tier 2 (430)
Tier 3 (1064)
Tier 4 (919)
Tier 5 (549)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
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
SilverScript Allure (PDP) (S5601-153-0)
Benefit Details           
The SilverScript Allure (PDP) (S5601-153-0)
Formulary Drugs Starting with the Letter E

in CMS PDP Region 11 which includes: FL
Plan Monthly Premium: $80.00 Deductible: $0 Qualifies for LIS: No
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 40%40%None
EDURANT 27.5mg/1   5 Specialty Tier 33%N/ANone
EFAVIRENZ 200 MG CAPSULE [Sustiva]   5 Specialty Tier 33%N/ANone
EFAVIRENZ 50 MG CAPSULE [Sustiva]   4 Non-Preferred Drug 40%40%None
EFAVIRENZ 600 MG TABLET [Sustiva]   5 Specialty Tier 33%N/ANone
ELIQUIS 2.5 MG TABLET   3 Preferred Brand 20%20%None
ELIQUIS 5 MG STARTER PACK   3 Preferred Brand 20%20%None
ELIQUIS 5 MG TABLET   3 Preferred Brand 20%20%None
EMBEDA ER 100-4 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
EMBEDA ER 20-0.8 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EMBEDA ER 30-1.2 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
EMBEDA ER 50-2 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
EMBEDA ER 60-2.4 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
EMBEDA ER 80-3.2 MG CAPSULE   3 Preferred Brand 20%20%P Q:60
/30Days
EMCYT 140MG CAPSULE   4 Non-Preferred Drug 40%40%None
EMEND 125 MG POWDER PACKET   4 Non-Preferred Drug 40%40%P
EMGALITY 120 MG/ML PEN INJCTR   3 Preferred Brand 20%20%P Q:2
/30Days
EMGALITY 120 MG/ML SYRINGE   3 Preferred Brand 20%20%P Q:2
/30Days
EMOQUETTE 28 DAY TABLET [Solia]   3 Preferred Brand 20%20%None
Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy]   3 Preferred Brand 20%20%Q:120
/30Days
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H   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
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H   5 Specialty Tier 33%N/AP Q:30
/30Days
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H   5 Specialty Tier 33%N/AP Q:30
/30Days
EMTRIVA 10MG/ML SOLUTION   3 Preferred Brand 20%20%None
EMTRIVA 200MG CAPSULE   3 Preferred Brand 20%20%None
EMVERM 100 MG TABLET CHEW   5 Specialty Tier 33%N/ANone
ENALAPRIL MALEATE 10 MG TAB   2 Generic $5.00$12.50None
ENALAPRIL MALEATE 2.5 MG TAB   2 Generic $5.00$12.50None
ENALAPRIL MALEATE 20 MG TAB   2 Generic $5.00$12.50None
ENALAPRIL MALEATE 5 MG TABLET   2 Generic $5.00$12.50None
Enalapril Maleate and Hydrochlorothiazide 10; 25mg/1; mg/1 100 TABLET BOTTLE, PLASTIC   2 Generic $5.00$12.50None
ENALAPRIL-HCTZ 5-12.5 MG TAB   2 Generic $5.00$12.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ENDARI 5 GRAM POWDER PACKET   5 Specialty Tier 33%N/AP
ENDOCET 10MG-325MG TABLET   3 Preferred Brand 20%20%Q:180
/30Days
ENDOCET 5/325 TABLET   3 Preferred Brand 20%20%Q:360
/30Days
ENDOCET 7.5-325MG TABLET   3 Preferred Brand 20%20%Q:240
/30Days
ENGERIX B INJECTION   3 Preferred Brand 20%20%P
ENGERIX-B 20 MCG/ML SYRN   3 Preferred Brand 20%20%P
ENOXAPARIN 100 MG/ML SYRINGE   4 Non-Preferred Drug 40%40%None
ENOXAPARIN 120 MG/0.8 ML SYRINGE   4 Non-Preferred Drug 40%40%None
ENOXAPARIN 150 MG/ML SYRINGE   4 Non-Preferred Drug 40%40%None
ENOXAPARIN 30 MG/0.3 ML SYR   4 Non-Preferred Drug 40%40%None
ENOXAPARIN 40 MG/0.4 ML SYR   4 Non-Preferred Drug 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ENOXAPARIN 60 MG/0.6 ML SYRINGE   4 Non-Preferred Drug 40%40%None
ENOXAPARIN 80 MG/0.8 ML SYRINGE   4 Non-Preferred Drug 40%40%None
ENSKYCE 28 TABLET [Solia]   3 Preferred Brand 20%20%None
ENSTILAR 0.005%-0.064% FOAM   4 Non-Preferred Drug 40%40%P
ENTACAPONE 200 MG TABLET [Comtan Entacapone]   4 Non-Preferred Drug 40%40%None
ENTECAVIR 0.5 MG TABLET [Baraclude]   4 Non-Preferred Drug 40%40%None
ENTECAVIR 1 MG TABLET [Baraclude]   4 Non-Preferred Drug 40%40%None
ENTRESTO 24 MG-26 MG TABLET   3 Preferred Brand 20%20%None
ENTRESTO 49 MG-51 MG TABLET   3 Preferred Brand 20%20%None
ENTRESTO 97 MG-103 MG TABLET   3 Preferred Brand 20%20%None
ENULOSE 10 GM/15 ML SOLUTION   2 Generic $5.00$12.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
EPCLUSA 400 MG-100 MG TABLET   5 Specialty Tier 33%N/AP
EPIDIOLEX 100 MG/ML SOLUTION   5 Specialty Tier 33%N/AP Q:600
/30Days
EPINEPHRINE 0.15 MG AUTO-INJECT   3 Preferred Brand 20%20%None
EPINEPHRINE 0.3 MG AUTO-INJECT   3 Preferred Brand 20%20%None
EPITOL 200MG TABLET   3 Preferred Brand 20%20%None
EPIVIR HBV 25MG/5ML TUBEX   4 Non-Preferred Drug 40%40%None
Eplerenone 25mg/1 90 TABLET BOTTLE   3 Preferred Brand 20%20%None
Eplerenone 50mg/1 90 TABLET BOTTLE   3 Preferred Brand 20%20%None
Ergotamine-caffeine 1-100mg tb   4 Non-Preferred Drug 40%40%None
ERIVEDGE 150 MG CAPSULE   5 Specialty Tier 33%N/AP
ERLEADA 60 MG TABLET   5 Specialty Tier 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ERLOTINIB HCL 100 MG TABLET [Tarceva]   5 Specialty Tier 33%N/AP Q:30
/30Days
ERLOTINIB HCL 150 MG TABLET [Tarceva]   5 Specialty Tier 33%N/AP Q:30
/30Days
ERLOTINIB HCL 25 MG TABLET [Tarceva]   5 Specialty Tier 33%N/AP Q:90
/30Days
Errin 0.35 mg tablet   3 Preferred Brand 20%20%None
ERTAPENEM 1 GRAM VIAL [Invanz]   4 Non-Preferred Drug 40%40%None
ERY 2% PADS 2% 60 PADS JAR   3 Preferred Brand 20%20%None
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE   4 Non-Preferred Drug 40%40%None
ERY-TAB TAB 250MG EC   4 Non-Preferred Drug 40%40%None
ERY-TAB TAB 333MG EC   4 Non-Preferred Drug 40%40%None
ERYTHROCIN 500MG ADDVNT VL   4 Non-Preferred Drug 40%40%None
ERYTHROCIN TAB 250MG   4 Non-Preferred Drug 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ERYTHROMYCIN 0.5% EYE OINTMENT   2 Generic $5.00$12.50None
ERYTHROMYCIN 2% GEL   4 Non-Preferred Drug 40%40%None
ERYTHROMYCIN 2% SOLUTION   3 Preferred Brand 20%20%None
ERYTHROMYCIN 500 MG FILMTAB   4 Non-Preferred Drug 40%40%None
ERYTHROMYCIN EC 250 MG CAP   4 Non-Preferred Drug 40%40%None
ERYTHROMYCIN ES 400 MG TAB   4 Non-Preferred Drug 40%40%None
ERYTHROMYCIN TAB 250MG BS   4 Non-Preferred Drug 40%40%None
ESBRIET 267 MG CAPSULE   5 Specialty Tier 33%N/AP
ESBRIET 267 MG TABLET   5 Specialty Tier 33%N/AP
ESBRIET 801 MG TABLET   5 Specialty Tier 33%N/AP
ESCITALOPRAM 10 MG TABLET [Lexapro]   2 Generic $5.00$12.50None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ESCITALOPRAM 20 MG TABLET [Lexapro]   2 Generic $5.00$12.50None
ESCITALOPRAM 5 MG TABLET [Lexapro]   2 Generic $5.00$12.50None
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro]   4 Non-Preferred Drug 40%40%None
ESOMEPRAZOLE MAG DR 20 MG CAP [Nexium]   3 Preferred Brand 20%20%Q:30
/30Days
ESOMEPRAZOLE MAG DR 40 MG CAP [Nexium]   3 Preferred Brand 20%20%Q:30
/30Days
ESTARYLLA 0.25-0.035 MG TABLET [VyLibra]   3 Preferred Brand 20%20%None
ESTRACE VAG CREAM 0.1MG/GM   3 Preferred Brand 20%20%None
ESTRADIOL 0.5 MG TABLET   2 Generic $5.00$12.50None
ESTRADIOL 1 MG TABLET   2 Generic $5.00$12.50None
ESTRADIOL 2MG TABLET   2 Generic $5.00$12.50None
ESTRADIOL TDS 0.025 MG/DAY   3 Preferred Brand 20%20%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ESTRADIOL TDS 0.0375 MG/DAY   3 Preferred Brand 20%20%None
ESTRADIOL TDS 0.05 MG/DAY   3 Preferred Brand 20%20%None
ESTRADIOL TDS 0.06 MG/DAY   3 Preferred Brand 20%20%None
ESTRADIOL TDS 0.075 MG/DAY   3 Preferred Brand 20%20%None
ESTRADIOL TDS 0.1 MG/DAY   3 Preferred Brand 20%20%None
ESTRADIOL VALERATE 20mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE   4 Non-Preferred Drug 40%40%None
ESTRADIOL VALERATE 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE   4 Non-Preferred Drug 40%40%None
ETHAMBUTOL HCL 400 MG TABLET   3 Preferred Brand 20%20%None
Ethambutol Hydrochloride 100mg/1   3 Preferred Brand 20%20%None
Ethinyl Estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]   3 Preferred Brand 20%20%None
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6   3 Preferred Brand 20%20%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21   3 Preferred Brand 20%20%None
ETHOSUXIMIDE 250 MG CAPSULE   4 Non-Preferred Drug 40%40%None
ETHOSUXIMIDE 250 MG/5 ML SOLN   4 Non-Preferred Drug 40%40%None
ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA]   3 Preferred Brand 20%20%None
ethynodiol-eth estra 1mg-50mcg [ZOVIA]   3 Preferred Brand 20%20%None
EVOTAZ 300 MG-150 MG TABLET   5 Specialty Tier 33%N/ANone
EXELON 13.3 MG/24HR PATCH   3 Preferred Brand 20%20%Q:30
/30Days
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS   3 Preferred Brand 20%20%Q:30
/30Days
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS   3 Preferred Brand 20%20%Q:30
/30Days
EXEMESTANE 25 MG TABLET   4 Non-Preferred Drug 40%40%None
EZETIMIBE 10 MG TABLET [Zetia]   4 Non-Preferred Drug 40%40%None

Chart Legend:

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