2020 Medicare Part D Plan Formulary Information |
BCN Advantage HMO-POS Classic (HMO-POS) (H5883-002-4)
Benefit Details
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The BCN Advantage HMO-POS Classic (HMO-POS) (H5883-002-4) Formulary Drugs Starting with the Letter S in Grand Traverse County, MI: CMS MA Region 11 which includes: MI Plan Monthly Premium: $103.30 Deductible: $0 |
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
SANTYL OINTMENT ![Compare how all Medicare Part D PDP plans in MI cover SANTYL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SAPHRIS 10 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in MI cover SAPHRIS 10 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | S |
SAPHRIS 2.5 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in MI cover SAPHRIS 2.5 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | S |
SAPHRIS 5 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in MI cover SAPHRIS 5 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | S |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MI cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | P |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MI cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | P |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MI cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | P |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in MI cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | P |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in MI cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | P |
SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop] ![Compare how all Medicare Part D PDP plans in MI cover SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SECUADO 3.8 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in MI cover SECUADO 3.8 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | S Q:31 /31Days |
SECUADO 5.7 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in MI cover SECUADO 5.7 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | S Q:31 /31Days |
SECUADO 7.6 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in MI cover SECUADO 7.6 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | S Q:31 /31Days |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MI cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SELZENTRY 20 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in MI cover SELZENTRY 20 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SELZENTRY 25 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SELZENTRY 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SELZENTRY 75 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SELZENTRY 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in MI cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:180 /90Days |
Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in MI cover Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in MI cover Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SERTRALINE 20 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in MI cover SERTRALINE 20 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SERTRALINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SERTRALINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SERTRALINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SERTRALINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SERTRALINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SERTRALINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SEVELAMER 0.8 GM POWDER PACKET [RENVELA] ![Compare how all Medicare Part D PDP plans in MI cover SEVELAMER 0.8 GM POWDER PACKET [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SEVELAMER 2.4 GM POWDER PACKET POWD PACK [Renvela] ![Compare how all Medicare Part D PDP plans in MI cover SEVELAMER 2.4 GM POWDER PACKET POWD PACK [Renvela].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SEVELAMER CARBONATE 800 MG TABLET [RENVELA] ![Compare how all Medicare Part D PDP plans in MI cover SEVELAMER CARBONATE 800 MG TABLET [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SEVELAMER HCL 400 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in MI cover SEVELAMER HCL 400 MG TABLET [RenaGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEVELAMER HCL 800 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in MI cover SEVELAMER HCL 800 MG TABLET [RenaGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SHAROBEL 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SHAROBEL 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SHINGRIX VIAL KIT ![Compare how all Medicare Part D PDP plans in MI cover SHINGRIX VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
Signifor .3 mg/mL ![Compare how all Medicare Part D PDP plans in MI cover Signifor .3 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Signifor .6 mg/mL ![Compare how all Medicare Part D PDP plans in MI cover Signifor .6 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Signifor .9 mg/mL ![Compare how all Medicare Part D PDP plans in MI cover Signifor .9 mg/mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio] ![Compare how all Medicare Part D PDP plans in MI cover SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:180 /30Days |
SILDENAFIL 20 MG TABLET [Revatio] ![Compare how all Medicare Part D PDP plans in MI cover SILDENAFIL 20 MG TABLET [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | P Q:270 /90Days |
SILVER SULFADIAZINE 1% CREAM ![Compare how all Medicare Part D PDP plans in MI cover SILVER SULFADIAZINE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SIMBRINZA 1%-0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in MI cover SIMBRINZA 1%-0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 |
$0.00 | $0.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 |
$0.00 | $0.00 | Q:90 /90Days |
SIMVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SIMVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 |
$0.00 | $0.00 | Q:90 /90Days |
SIMVASTATIN 5 MG TABLET [Zocor] ![Compare how all Medicare Part D PDP plans in MI cover SIMVASTATIN 5 MG TABLET [Zocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 |
$0.00 | $0.00 | Q:90 /90Days |
SIMVASTATIN 80 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SIMVASTATIN 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Tier 6 |
$0.00 | $0.00 | Q:90 /90Days |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in MI cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in MI cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
SIROLIMUS 1 MG/ML SOLUTION [Rapamune] ![Compare how all Medicare Part D PDP plans in MI cover SIROLIMUS 1 MG/ML SOLUTION [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in MI cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SKLICE 0.5% LOTION ![Compare how all Medicare Part D PDP plans in MI cover SKLICE 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SODIUM CHLORIDE 0.45% Sodium Chloride Injection, USP ![Compare how all Medicare Part D PDP plans in MI cover SODIUM CHLORIDE 0.45% Sodium Chloride Injection, USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE 0.9% IRRIG. ![Compare how all Medicare Part D PDP plans in MI cover SODIUM CHLORIDE 0.9% IRRIG..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SODIUM CHLORIDE 0.9% IV SOLN ![Compare how all Medicare Part D PDP plans in MI cover SODIUM CHLORIDE 0.9% IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SODIUM CHLORIDE 3% IV SOLUTION ![Compare how all Medicare Part D PDP plans in MI cover SODIUM CHLORIDE 3% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in MI cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SODIUM PHENYLBUTYRATE 500MG TB [Buphenyl] ![Compare how all Medicare Part D PDP plans in MI cover SODIUM PHENYLBUTYRATE 500MG TB [Buphenyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SODIUM PHENYLBUTYRATE POWDER [Buphenyl] ![Compare how all Medicare Part D PDP plans in MI cover SODIUM PHENYLBUTYRATE POWDER [Buphenyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SODIUM POLYSTYRENE SULF POWDER ![Compare how all Medicare Part D PDP plans in MI cover SODIUM POLYSTYRENE SULF POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa] ![Compare how all Medicare Part D PDP plans in MI cover SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOLIFENACIN 10 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in MI cover SOLIFENACIN 10 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SOLIFENACIN 5 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in MI cover SOLIFENACIN 5 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SOLTAMOX 20 MG/10 ML SOLN Solution ![Compare how all Medicare Part D PDP plans in MI cover SOLTAMOX 20 MG/10 ML SOLN Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOMATULINE DEPOT 120 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover SOMATULINE DEPOT 120 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SOMATULINE DEPOT 60 MG/0.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover SOMATULINE DEPOT 60 MG/0.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SOMATULINE DEPOT 90 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover SOMATULINE DEPOT 90 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in MI cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in MI cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in MI cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOMAVERT 25 MG VIAL ![Compare how all Medicare Part D PDP plans in MI cover SOMAVERT 25 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOMAVERT 30 MG VIAL ![Compare how all Medicare Part D PDP plans in MI cover SOMAVERT 30 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MI cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MI cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MI cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in MI cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL 120 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL 120 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL 240 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL 240 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL AF 120 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL AF 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL AF 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL AF 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOTALOL AF 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in MI cover SOTALOL AF 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SOVALDI 150 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in MI cover SOVALDI 150 MG PELLET PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOVALDI 200 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in MI cover SOVALDI 200 MG PELLET PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SOVALDI 400 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SOVALDI 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPIRIVA 18 MCG CP-HANDIHALER ![Compare how all Medicare Part D PDP plans in MI cover SPIRIVA 18 MCG CP-HANDIHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:90 /90Days |
SPIRIVA RESPIMAT 1.25 MCG INH ![Compare how all Medicare Part D PDP plans in MI cover SPIRIVA RESPIMAT 1.25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:90 /90Days |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in MI cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:90 /90Days |
SPIRONOLACTONE 100 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in MI cover SPIRONOLACTONE 100 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SPIRONOLACTONE 25 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in MI cover SPIRONOLACTONE 25 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SPIRONOLACTONE 50 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in MI cover SPIRONOLACTONE 50 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide] ![Compare how all Medicare Part D PDP plans in MI cover SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SPRITAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRITAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SPRITAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRITAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SPRITAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRITAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRITAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRITAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SPS 15 GM/60 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in MI cover SPS 15 GM/60 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in MI cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
STAVUDINE 15 MG CAPSULE [Zerit] ![Compare how all Medicare Part D PDP plans in MI cover STAVUDINE 15 MG CAPSULE [Zerit].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
STAVUDINE 20 MG CAPSULE [Zerit] ![Compare how all Medicare Part D PDP plans in MI cover STAVUDINE 20 MG CAPSULE [Zerit].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STAVUDINE 30 MG CAPSULE [Zerit] ![Compare how all Medicare Part D PDP plans in MI cover STAVUDINE 30 MG CAPSULE [Zerit].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
STAVUDINE 40 MG CAPSULE [Zerit] ![Compare how all Medicare Part D PDP plans in MI cover STAVUDINE 40 MG CAPSULE [Zerit].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
STELARA 45 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in MI cover STELARA 45 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in MI cover Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in MI cover Stimate 1.5mg/mL 1 BOTTLE, SPRAY per CARTON / 2.5 mL in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
STIOLTO RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in MI cover STIOLTO RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in MI cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in MI cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULF-PRED 10-0.23% EYE DROPS ![Compare how all Medicare Part D PDP plans in MI cover SULF-PRED 10-0.23% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SULFACETAMIDE 10% EYE DROPS [Sulf-10] ![Compare how all Medicare Part D PDP plans in MI cover SULFACETAMIDE 10% EYE DROPS [Sulf-10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in MI cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SULFACETAMIDE SOD 10% TOP SUSP ![Compare how all Medicare Part D PDP plans in MI cover SULFACETAMIDE SOD 10% TOP SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Sulfadiazine 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover Sulfadiazine 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS] ![Compare how all Medicare Part D PDP plans in MI cover SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SULFAMETHOXAZOLE-TMP SS TABLET [Septra] ![Compare how all Medicare Part D PDP plans in MI cover SULFAMETHOXAZOLE-TMP SS TABLET [Septra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SULFAMETHOXAZOLE-TMP SUSP Oral Suspension [Sultrex Pediatric] ![Compare how all Medicare Part D PDP plans in MI cover SULFAMETHOXAZOLE-TMP SUSP Oral Suspension [Sultrex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SULFASALAZINE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SULFASALAZINE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SULFASALAZINE DR 500 MG TABLET [Sulfazine EC] ![Compare how all Medicare Part D PDP plans in MI cover SULFASALAZINE DR 500 MG TABLET [Sulfazine EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$1.00 | $3.00 | None |
SULINDAC 150 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SULINDAC 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULINDAC 200 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SULINDAC 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Sumatriptan 20 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in MI cover Sumatriptan 20 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:36 /90Days |
SUMATRIPTAN 4 MG/0.5 ML CART ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN 4 MG/0.5 ML CART.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Sumatriptan 4 mg/0.5 ml inject ![Compare how all Medicare Part D PDP plans in MI cover Sumatriptan 4 mg/0.5 ml inject.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Sumatriptan 5 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in MI cover Sumatriptan 5 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:36 /90Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SUMATRIPTAN 6 MG/0.5 ML SYRNG Syringe [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN 6 MG/0.5 ML SYRNG Syringe [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
Sumatriptan 6 mg/0.5 ml vial ![Compare how all Medicare Part D PDP plans in MI cover Sumatriptan 6 mg/0.5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SUMATRIPTAN SUCC 100 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN SUCC 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SUMATRIPTAN SUCC 25 MG TABLET [Imitrex] ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN SUCC 25 MG TABLET [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack] ![Compare how all Medicare Part D PDP plans in MI cover SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$7.00 | $21.00 | None |
SUPRAX 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MI cover SUPRAX 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SUPREP BOWEL PREP KIT SOLN RECON ![Compare how all Medicare Part D PDP plans in MI cover SUPREP BOWEL PREP KIT SOLN RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in MI cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SUTENT 25mg/1 28 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in MI cover SUTENT 25mg/1 28 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SUTENT 37.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MI cover SUTENT 37.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MI cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SYLATRON 200 MCG KIT ![Compare how all Medicare Part D PDP plans in MI cover SYLATRON 200 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SYLATRON 300 MCG KIT ![Compare how all Medicare Part D PDP plans in MI cover SYLATRON 300 MCG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in MI cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:31 /90Days |
SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER ![Compare how all Medicare Part D PDP plans in MI cover SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | Q:31 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMFI 600-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SYMFI 600-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SYMFI LO 400-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SYMFI LO 400-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SYMJEPI 0.15 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover SYMJEPI 0.15 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SYMJEPI 0.3 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in MI cover SYMJEPI 0.3 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MI cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in MI cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
SYMPAZAN 10 MG FILM ![Compare how all Medicare Part D PDP plans in MI cover SYMPAZAN 10 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SYMPAZAN 20 MG FILM ![Compare how all Medicare Part D PDP plans in MI cover SYMPAZAN 20 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SYMPAZAN 5 MG FILM ![Compare how all Medicare Part D PDP plans in MI cover SYMPAZAN 5 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
SYMTUZA 800-150-200-10 MG TABLET ![Compare how all Medicare Part D PDP plans in MI cover SYMTUZA 800-150-200-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MI cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$38.00 | $114.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MI cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |