2020 Medicare Part D Plan Formulary Information |
Anthem MediBlue Plus (HMO) (H3447-023-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The Anthem MediBlue Plus (HMO) (H3447-023-0) Formulary Drugs Starting with the Letter L in Jackson County, IN: CMS MA Region 13 which includes: IN Plan Monthly Premium: $0.00 Deductible: $75 |
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LABETALOL HCL 200 MG TABLET [Trandate] ![Compare how all Medicare Part D PDP plans in IN cover LABETALOL HCL 200 MG TABLET [Trandate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LABETALOL HCL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LABETALOL HCL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LACRISERT 5 MG INS ![Compare how all Medicare Part D PDP plans in IN cover LACRISERT 5 MG INS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:60 /30Days |
LACTULOSE 10 GM/15 ML SOLUTION [Constulose] ![Compare how all Medicare Part D PDP plans in IN cover LACTULOSE 10 GM/15 ML SOLUTION [Constulose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir] ![Compare how all Medicare Part D PDP plans in IN cover LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:960 /30Days |
LAMIVUDINE 150 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in IN cover LAMIVUDINE 150 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
LAMIVUDINE 300 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in IN cover LAMIVUDINE 300 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:30 /30Days |
LAMIVUDINE HBV 100 MG TABLET [Epivir HBV] ![Compare how all Medicare Part D PDP plans in IN cover LAMIVUDINE HBV 100 MG TABLET [Epivir HBV].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LAMIVUDINE-ZIDOVUDINE TABLET [Combivir] ![Compare how all Medicare Part D PDP plans in IN cover LAMIVUDINE-ZIDOVUDINE TABLET [Combivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE 100 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 100 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LAMOTRIGINE 150 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 150 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LAMOTRIGINE 200 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 200 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LAMOTRIGINE 25 MG DISPER TABLET CHW [Lamictal CD] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 25 MG DISPER TABLET CHW [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LAMOTRIGINE 25 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 25 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHW [Lamictal CD] ![Compare how all Medicare Part D PDP plans in IN cover LAMOTRIGINE 5 MG DISPER TABLET CHW [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LANOXIN 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LANOXIN 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LANOXIN 62.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LANOXIN 62.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
![Compare how all Medicare Part D PDP plans in IN cover LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LANSOPRAZOLE DR 30 MG CAPSULE DR [Prevacid] ![Compare how all Medicare Part D PDP plans in IN cover LANSOPRAZOLE DR 30 MG CAPSULE DR [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:30 /30Days |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in IN cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LARISSIA-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in IN cover LARISSIA-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:30 /30Days |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:240 /30Days |
LATUDA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LATUDA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:120 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 80 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LATUDA 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:60 /30Days |
LEENA 28 TABLET [Tri-Norinyl] ![Compare how all Medicare Part D PDP plans in IN cover LEENA 28 TABLET [Tri-Norinyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEFLUNOMIDE 10 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in IN cover LEFLUNOMIDE 10 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEFLUNOMIDE 20 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in IN cover LEFLUNOMIDE 20 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
LENVIMA 12 MG DAILY DOSE CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 12 MG DAILY DOSE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:90 /30Days |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:60 /30Days |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:90 /30Days |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:60 /30Days |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:90 /30Days |
LENVIMA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in IN cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:60 /30Days |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IN cover Lessina 3 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) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LETAIRIS 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LETAIRIS 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
LETAIRIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LETAIRIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | Q:30 /30Days |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEUCOVORIN CALCIUM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEUCOVORIN CALCIUM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEUCOVORIN CALCIUM 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEUCOVORIN CALCIUM 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in IN cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric] ![Compare how all Medicare Part D PDP plans in IN cover LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:270 /30Days |
LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in IN cover LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:540 /30Days |
LEVALBUTEROL 1.25 MG/0.5 ML ![Compare how all Medicare Part D PDP plans in IN cover LEVALBUTEROL 1.25 MG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:270 /30Days |
LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in IN cover LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:270 /30Days |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex] ![Compare how all Medicare Part D PDP plans in IN cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:45 /30Days |
LEVEMIR 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover LEVEMIR 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVEMIR FLEXTOUCH 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in IN cover LEVEMIR FLEXTOUCH 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVETIRACETAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVETIRACETAM 100 MG/ML SOLUTION [Keppra] ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM 100 MG/ML SOLUTION [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVETIRACETAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEVETIRACETAM 500 MG TABLET [Roweepra] ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM 500 MG TABLET [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEVETIRACETAM ER 500 MG TABLET ER 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM ER 500 MG TABLET ER 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
LEVETIRACETAM ER 750 MG TABLET ER 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in IN cover LEVETIRACETAM ER 750 MG TABLET ER 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:120 /30Days |
LEVO-T 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVO-T 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVO-T 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVO-T 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOBUNOLOL 0.5% EYE DROPS [Betagan] ![Compare how all Medicare Part D PDP plans in IN cover LEVOBUNOLOL 0.5% EYE DROPS [Betagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEVOCARNITINE 1 G/10 ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover LEVOCARNITINE 1 G/10 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P |
LEVOCETIRIZINE 2.5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover LEVOCETIRIZINE 2.5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour] ![Compare how all Medicare Part D PDP plans in IN cover LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOFLOXACIN 500 MG TABLET [Levaquin] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 500 MG TABLET [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in IN cover Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in IN cover LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVONOR-ETH ESTRAD 0.09-0.02 MG ![Compare how all Medicare Part D PDP plans in IN cover LEVONOR-ETH ESTRAD 0.09-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVONOR-ETH ESTRAD 0.1-0.02 MG Tablet [Vienva] ![Compare how all Medicare Part D PDP plans in IN cover LEVONOR-ETH ESTRAD 0.1-0.02 MG Tablet [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in IN cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in IN cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Levonor-eth Estrad 0.15-0.03-0.01 ![Compare how all Medicare Part D PDP plans in IN cover Levonor-eth Estrad 0.15-0.03-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in IN cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in IN cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:1800 /30Days |
LEXIVA 700MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover LEXIVA 700MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:120 /30Days |
LIALDA 1.2G TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IN cover LIALDA 1.2G TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LIDOCAINE 2% VISCOUS SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE 2% VISCOUS SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LIDOCAINE 5% OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE 5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:150 /30Days |
LIDOCAINE 5% PATCH [Lidoderm] ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE 5% PATCH [Lidoderm].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:90 /30Days |
LIDOCAINE HCL 2% JELLY 30ML TUBE ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE HCL 2% JELLY 30ML TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIDOCAINE HCL IV 4% SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE HCL IV 4% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | P Q:300 /30Days |
LIDOCAINE-PRILOCAINE CREAM (g) [SOLUPICC] ![Compare how all Medicare Part D PDP plans in IN cover LIDOCAINE-PRILOCAINE CREAM (g) [SOLUPICC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:30 /30Days |
LINDANE SHAMPOO 1MG 2 FLO BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover LINDANE SHAMPOO 1MG 2 FLO BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox] ![Compare how all Medicare Part D PDP plans in IN cover LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1800 /30Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in IN cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:56 /28Days |
LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox] ![Compare how all Medicare Part D PDP plans in IN cover LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
LIOTHYRONINE SOD 25 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in IN cover LIOTHYRONINE SOD 25 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LIOTHYRONINE SOD 5 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in IN cover LIOTHYRONINE SOD 5 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in IN cover LIOTHYRONINE SOD 50 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LIPITOR 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LIPITOR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL-HCTZ 10-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL-HCTZ 20-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LISINOPRIL-HCTZ 20-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHIUM CARBONATE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LITHIUM CARBONATE 300 MG CAPSULE [Eskalith] ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE 300 MG CAPSULE [Eskalith].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $4.00 | None |
LITHIUM CARBONATE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LITHIUM CARBONATE 600 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE 600 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LITHIUM CARBONATE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR] ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in IN cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LO LOESTRIN FE 1-10 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LO LOESTRIN FE 1-10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
LOPERAMIDE 2 MG CAPSULE [Tagamet] ![Compare how all Medicare Part D PDP plans in IN cover LOPERAMIDE 2 MG CAPSULE [Tagamet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOPID 600 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOPID 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in IN cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:480 /30Days |
LOPREEZA 1 MG-0.5 MG TABLET [Mimvey] ![Compare how all Medicare Part D PDP plans in IN cover LOPREEZA 1 MG-0.5 MG TABLET [Mimvey].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | Q:90 /30Days |
LORAZEPAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORAZEPAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | Q:90 /30Days |
LORAZEPAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORAZEPAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$9.00 | $18.00 | Q:150 /30Days |
LORAZEPAM 2 MG/ML ORAL CONCENT ![Compare how all Medicare Part D PDP plans in IN cover LORAZEPAM 2 MG/ML ORAL CONCENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:150 /30Days |
LORBRENA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORBRENA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
LORBRENA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORBRENA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:90 /30Days |
LORCET 5-325 MG TABLET [Norco] ![Compare how all Medicare Part D PDP plans in IN cover LORCET 5-325 MG TABLET [Norco].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
LORCET HD 10-325 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LORCET HD 10-325 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lorcet plus 7.5-325 mg tablet ![Compare how all Medicare Part D PDP plans in IN cover Lorcet plus 7.5-325 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in IN cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOSARTAN POTASSIUM 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN POTASSIUM 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 25 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN POTASSIUM 25 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN POTASSIUM 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN-HCTZ 100-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 50-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOSARTAN-HCTZ 50-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOTENSIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOTENSIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOTENSIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOTENSIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOTENSIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOTENSIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LOVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOW-OGESTREL-28 TABLET [Low-Ogestrel] ![Compare how all Medicare Part D PDP plans in IN cover LOW-OGESTREL-28 TABLET [Low-Ogestrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOXAPINE 10 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in IN cover LOXAPINE 10 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LOXAPINE 25 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in IN cover LOXAPINE 25 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LOXAPINE 5 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in IN cover LOXAPINE 5 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LOXAPINE 50 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in IN cover LOXAPINE 50 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /84Days |
LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /84Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /28Days |
LUPRON DEPOT 45 MG 6MO KIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT 45 MG 6MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /168Days |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /28Days |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in IN cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:1 /112Days |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in IN cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:120 /30Days |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:120 /30Days |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:180 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:120 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:900 /30Days |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:720 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:360 /30Days |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:240 /30Days |
LYSODREN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LYSODREN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |