2020 Medicare Part D Plan Formulary Information |
BlueCross Total (PPO) (H8003-002-0)
Benefit Details
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The BlueCross Total (PPO) (H8003-002-0) Formulary Drugs Starting with the Letter O in Calhoun County, SC: CMS MA Region 8 which includes: SC Plan Monthly Premium: $15.00 Deductible: $70 |
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCALIVA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OCALIVA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:30 /30Days |
OCALIVA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OCALIVA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:30 /30Days |
OCELLA 3MG/0.03MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OCELLA 3MG/0.03MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OCTAGAM 10% VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTAGAM 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OCTAGAM 5% VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTAGAM 5% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OCTREOTIDE 1,000 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE 1,000 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OCTREOTIDE ACET 0.05 MG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 0.05 MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P |
OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P |
OCTREOTIDE ACET 200 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 200 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P |
OCTREOTIDE ACET 500 MCG/ML VL ![Compare how all Medicare Part D PDP plans in SC cover OCTREOTIDE ACET 500 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in SC cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
ODEFSEY TABLET ![Compare how all Medicare Part D PDP plans in SC cover ODEFSEY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | Q:30 /30Days |
ODOMZO 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ODOMZO 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OFEV 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OFEV 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OFEV 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OFEV 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OFLOXACIN 0.3 % DRP ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 0.3 % DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OFLOXACIN 0.3% EAR DROPS [Floxin] ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 0.3% EAR DROPS [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OFLOXACIN 300 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 300 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OFLOXACIN 400 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in SC cover OFLOXACIN 400 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLANZAPINE 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 10 MG VIAL ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 2.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 2.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 7.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE 7.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:30 /30Days |
OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days |
OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days |
OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days |
OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:90 /30Days |
OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:90 /30Days |
OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in SC cover OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:30 /30Days |
OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in SC cover OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
Olopatadine 2 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in SC cover Olopatadine 2 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLOPATADINE 665 MCG NASAL SPRY ![Compare how all Medicare Part D PDP plans in SC cover OLOPATADINE 665 MCG NASAL SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | Q:31 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLOPATADINE HCL 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover OLOPATADINE HCL 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OLUMIANT 1 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OLUMIANT 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OLUMIANT 2 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OLUMIANT 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza] ![Compare how all Medicare Part D PDP plans in SC cover OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | Q:60 /30Days |
OMEPRAZOLE-BICARB 20-1,100 CAPSULE [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 20-1,100 CAPSULE [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | Q:30 /30Days |
OMEPRAZOLE-BICARB 20-1,680 PACKET [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 20-1,680 PACKET [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | Q:60 /30Days |
OMEPRAZOLE-BICARB 40-1,100 CAPSULE [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 40-1,100 CAPSULE [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | Q:30 /30Days |
OMEPRAZOLE-BICARB 40-1,680 PACKET [Zegerid] ![Compare how all Medicare Part D PDP plans in SC cover OMEPRAZOLE-BICARB 40-1,680 PACKET [Zegerid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG ![Compare how all Medicare Part D PDP plans in SC cover OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in SC cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ONDANSETRON 4 MG/5 ML SOLUTION [Zofran] ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON 4 MG/5 ML SOLUTION [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P Q:450 /30Days |
ONDANSETRON HCL 24 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 24 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P Q:14 /28Days |
ONDANSETRON HCL 4 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 4 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | P |
ONDANSETRON HCL 8 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON HCL 8 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | P |
ONDANSETRON ODT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON ODT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | P |
ONDANSETRON ODT 8 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONDANSETRON ODT 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | P |
ONGLYZA 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONGLYZA 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | S |
ONGLYZA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ONGLYZA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | S |
OPSUMIT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OPSUMIT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORENCIA 125 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in SC cover ORENCIA 125 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.4 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in SC cover Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.4 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.7 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in SC cover Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.7 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ORENCIA CLICKJECT 125 MG/ML ![Compare how all Medicare Part D PDP plans in SC cover ORENCIA CLICKJECT 125 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:4 /28Days |
Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in SC cover Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ORENITRAM ER 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORENITRAM ER 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
ORENITRAM ER 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORENITRAM ER 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ORENITRAM ER 1 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORENITRAM ER 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ORENITRAM ER 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORENITRAM ER 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
ORFADIN 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | None |
ORFADIN 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORFADIN 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | None |
ORFADIN 4 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 4 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | None |
ORFADIN 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover ORFADIN 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | None |
ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ ![Compare how all Medicare Part D PDP plans in SC cover ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:56 /28Days |
ORILISSA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORILISSA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:30 /30Days |
ORILISSA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORILISSA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:60 /30Days |
ORKAMBI 100 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 100 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:112 /28Days |
ORKAMBI 100-125 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 100-125 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:56 /28Days |
ORKAMBI 150-188 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 150-188 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:56 /28Days |
ORKAMBI 200 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover ORKAMBI 200 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:112 /28Days |
ORPHENADRINE ER 100 MG TABLET [Norflex] ![Compare how all Medicare Part D PDP plans in SC cover ORPHENADRINE ER 100 MG TABLET [Norflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORSYTHIA-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in SC cover ORSYTHIA-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:1080 /365Days |
OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:168 /365Days |
OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:84 /365Days |
OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in SC cover OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | Q:110 /365Days |
OSPHENA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OSPHENA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$37.00 | $92.50 | P Q:30 /30Days |
OTEZLA 28 DAY STARTER PACK ![Compare how all Medicare Part D PDP plans in SC cover OTEZLA 28 DAY STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OTEZLA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OTEZLA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P |
OXACILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXACILLIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 1GM/50ML INJ.](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 |
OXACILLIN 2 GM VIAL ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 2 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in SC cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXANDROLONE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXANDROLONE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:60 /30Days |
OXANDROLONE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXANDROLONE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P Q:240 /30Days |
OXAPROZIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXAPROZIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXAZEPAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P Q:120 /30Days |
OXAZEPAM 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P Q:120 /30Days |
OXAZEPAM 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SC cover OXAZEPAM 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | P Q:120 /30Days |
OXBRYTA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXBRYTA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:90 /30Days |
OXCARBAZEPINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXCARBAZEPINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXCARBAZEPINE 600 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXCARBAZEPINE 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXERVATE 0.002% EYE DROPS ![Compare how all Medicare Part D PDP plans in SC cover OXERVATE 0.002% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | 31% | P Q:56 /28Days |
OXICONAZOLE NITRATE 1% CREAM (g) [Oxistat] ![Compare how all Medicare Part D PDP plans in SC cover OXICONAZOLE NITRATE 1% CREAM (g) [Oxistat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXISTAT 1% LOTION ![Compare how all Medicare Part D PDP plans in SC cover OXISTAT 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYBUTYNIN 5 MG TABLET [Ditropan] ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN 5 MG TABLET [Ditropan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYBUTYNIN 5 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN 5 MG/5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $0.00 | None |
OXYBUTYNIN CL ER 10 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 10 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYBUTYNIN CL ER 15 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in SC cover OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODON-ACETAMINOPHEN 2.5-325 ![Compare how all Medicare Part D PDP plans in SC cover OXYCODON-ACETAMINOPHEN 2.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODON-ACETAMINOPHEN 7.5-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODON-ACETAMINOPHEN 7.5-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 10 MG TABLET [Dazidox] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 10 MG TABLET [Dazidox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYCODONE HCL 15 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 15 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 20 MG TABLET [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 20 MG TABLET [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 30 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 30 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 5 MG CAPSULE [OxyIR] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG CAPSULE [OxyIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 5 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE HCL 5 MG/5 ML SOLN Solution [Roxicodone] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE HCL 5 MG/5 ML SOLN Solution [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE-ASPIRIN 4.8355-325 TABLET [Percodan] ![Compare how all Medicare Part D PDP plans in SC cover OXYCODONE-ASPIRIN 4.8355-325 TABLET [Percodan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYMORPHONE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYMORPHONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $37.50 | None |
OXYMORPHONE HCL ER 10 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 10 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 15 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 15 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 30 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 30 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in SC cover OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
45% | 45% | None |
OZEMPIC 0.25-0.5 MG DOSE PEN ![Compare how all Medicare Part D PDP plans in SC cover OZEMPIC 0.25-0.5 MG DOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$37.00 | $92.50 | Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OZEMPIC 1 MG DOSE PEN ![Compare how all Medicare Part D PDP plans in SC cover OZEMPIC 1 MG DOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$37.00 | $92.50 | Q:3 /28Days |