2020 Medicare Part D Plan Formulary Information |
Aetna Medicare Premier Advantra (PPO) (H1608-001-0)
Benefit Details
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The Aetna Medicare Premier Advantra (PPO) (H1608-001-0) Formulary Drugs Starting with the Letter B in Bremer County, IA: CMS MA Region 19 which includes: IA Plan Monthly Premium: $0.00 Deductible: $0 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in IA cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in IA cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BACLOFEN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BACLOFEN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BACLOFEN 20 MG TABLET [Lioresal] ![Compare how all Medicare Part D PDP plans in IA cover BACLOFEN 20 MG TABLET [Lioresal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BACLOFEN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BACLOFEN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal] ![Compare how all Medicare Part D PDP plans in IA cover BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BALVERSA 3 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BALVERSA 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:84 /28Days |
BALVERSA 4 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BALVERSA 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:56 /28Days |
BALVERSA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BALVERSA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:28 /28Days |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IA cover Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in IA cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BANZEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BANZEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in IA cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BASAGLAR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in IA cover BASAGLAR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in IA cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BELSOMRA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BELSOMRA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
BELSOMRA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BELSOMRA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
BELSOMRA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BELSOMRA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
BELSOMRA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BELSOMRA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
BENAZEPRIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in IA cover BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$0.00 | $0.00 | None |
BENLYSTA 200 MG/ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in IA cover BENLYSTA 200 MG/ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BENLYSTA 200 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover BENLYSTA 200 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BENZTROPINE MES 0.5 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MES 0.5 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | P |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in IA cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | P |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in IA cover BERINERT 500 UNIT KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:24 /30Days |
BESER 0.05% LOTION [Cutivate] ![Compare how all Medicare Part D PDP plans in IA cover BESER 0.05% LOTION [Cutivate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:120 /30Days |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in IA cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in IA cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BETAMETHASONE DP 0.05% LOTION ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETAMETHASONE DP 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak] ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BETAMETHASONE DP AUG 0.05% LOTION ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP AUG 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene] ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETAMETHASONE VALER 0.12% FOAM [Luxiq Foam] ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VALER 0.12% FOAM [Luxiq Foam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BETAMETHASONE VALERATE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VALERATE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in IA cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETASERON 0.3 MG KIT ![Compare how all Medicare Part D PDP plans in IA cover BETASERON 0.3 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:14 /28Days |
BETAXOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETAXOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETAXOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETAXOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Betaxolol 5 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in IA cover Betaxolol 5 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETHANECHOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETHANECHOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETHANECHOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETHANECHOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BETHANECHOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in IA cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BEVESPI AEROSPHERE INHALER ![Compare how all Medicare Part D PDP plans in IA cover BEVESPI AEROSPHERE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:11 /30Days |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in IA cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BICALUTAMIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BICALUTAMIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in IA cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in IA cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BIDIL TABLET ![Compare how all Medicare Part D PDP plans in IA cover BIDIL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BIKTARVY 50-200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BIKTARVY 50-200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BISOPROLOL FUMARATE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BISOPROLOL FUMARATE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL FUMARATE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BISOPROLOL-HCTZ 10-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL-HCTZ 10-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BISOPROLOL-HCTZ 2.5-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL-HCTZ 2.5-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BISOPROLOL-HCTZ 5-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BISOPROLOL-HCTZ 5-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BIVIGAM 10% VIAL [Panzyga] ![Compare how all Medicare Part D PDP plans in IA cover BIVIGAM 10% VIAL [Panzyga].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BLEPHAMIDE 10-0.2% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover BLEPHAMIDE 10-0.2% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BLISOVI 24 FE TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in IA cover BLISOVI 24 FE TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30] ![Compare how all Medicare Part D PDP plans in IA cover BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in IA cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BOSENTAN 125 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in IA cover BOSENTAN 125 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
BOSENTAN 62.5 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in IA cover BOSENTAN 62.5 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:120 /30Days |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BOSULIF 400 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BOSULIF 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BOSULIF 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRAFTOVI 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover BRAFTOVI 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in IA cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in IA cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BRIMONIDINE 0.2% EYE DROPS [Alphagan] ![Compare how all Medicare Part D PDP plans in IA cover BRIMONIDINE 0.2% EYE DROPS [Alphagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BRIMONIDINE TARTRATE 0.15% DROPS ![Compare how all Medicare Part D PDP plans in IA cover BRIMONIDINE TARTRATE 0.15% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRIVIACT 10 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 10 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom] ![Compare how all Medicare Part D PDP plans in IA cover BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in IA cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in IA cover BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BROMSITE 0.075% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover BROMSITE 0.075% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BRUKINSA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover BRUKINSA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:120 /30Days |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in IA cover BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
BUMETANIDE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BUMETANIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BUMETANIDE 1 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 1 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUMETANIDE 2 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in IA cover BUMETANIDE 2 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:90 /30Days |
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:90 /30Days |
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:90 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | Q:90 /30Days |
BUPRENORPHINE 10 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 10 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:4 /28Days |
BUPRENORPHINE 15 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 15 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:4 /28Days |
BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:90 /30Days |
BUPRENORPHINE 20 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 20 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:4 /28Days |
BUPRENORPHINE 5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:4 /28Days |
BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | P Q:90 /30Days |
BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone] ![Compare how all Medicare Part D PDP plans in IA cover BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | Q:90 /30Days |
BUPROPION HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:180 /30Days |
BUPROPION HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:180 /30Days |
BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BUPROPION HCL SR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL SR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUSPIRONE HCL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BUSPIRONE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BUSPIRONE HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BUSPIRONE HYDROCHLORIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$10.00 | $25.00 | None |
BUTORPHANOL 10 MG/ML SPRAY [Stadol NS] ![Compare how all Medicare Part D PDP plans in IA cover BUTORPHANOL 10 MG/ML SPRAY [Stadol NS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:5 /30Days |
BYDUREON 2 MG PEN INJECT ![Compare how all Medicare Part D PDP plans in IA cover BYDUREON 2 MG PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:4 /28Days |
BYDUREON BCISE 2 MG AUTOINJECT ![Compare how all Medicare Part D PDP plans in IA cover BYDUREON BCISE 2 MG AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:3 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in IA cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:2 /30Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in IA cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:1 /30Days |
Bystolic 10mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Bystolic 10mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bystolic 2.5mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Bystolic 2.5mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |
BYSTOLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover BYSTOLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
Bystolic 5mg 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Bystolic 5mg 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:30 /30Days |