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2020 Medicare Part D and Medicare Advantage Plan Formulary Browser

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SOLIS SPF 001 (HMO) (H0982-001-0)
Tier 1 (716)
Tier 2 (1780)
Tier 3 (465)
Tier 4 (1475)
Tier 5 (618)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2020 Medicare Part D Plan Formulary Information
SOLIS SPF 001 (HMO) (H0982-001-0)
Benefits & Contact Info           
The SOLIS SPF 001 (HMO) (H0982-001-0)
Formulary Drugs Starting with the Letter F

in Miami-Dade County, FL: CMS MA Region 9 which includes: FL
Plan Monthly Premium: $0.00 Deductible: $0
Drugs Starting with Letter F

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
FALMINA-28 TABLET   2 Tier 2 $0.00$0.00None
FAMCICLOVIR 125 MG TABLET   2 Tier 2 $0.00$0.00None
FAMCICLOVIR 250 MG TABLET   2 Tier 2 $0.00$0.00None
FAMCICLOVIR 500 MG TABLET   2 Tier 2 $0.00$0.00None
FAMOTIDINE 20 MG TABLET   1 Tier 1 $0.00$0.00None
FAMOTIDINE 40 MG TABLET   1 Tier 1 $0.00$0.00None
FAMOTIDINE 50 MG/5MLFOR ORAL SUSPENSION   2 Tier 2 $0.00$0.00None
FANAPT 1 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT 10 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT 12 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FANAPT 2 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT 4 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT 6 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT 8 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
FANAPT TITR TABLETS   4 Tier 4 $35.00N/AP Q:60
/30Days
FARXIGA 10 MG TABLET   3 Tier 3 $0.00N/AQ:30
/30Days
FARXIGA 5 MG TABLET   3 Tier 3 $0.00N/AQ:30
/30Days
FARYDAK 10 MG CAPSULE   5 Tier 5 33%N/AP
FARYDAK 20 MG CAPSULE   5 Tier 5 33%N/AP
FASENRA 30 MG/ML SYRINGE   5 Tier 5 33%N/AP
FASENRA PEN 30 MG/ML AUTO INJCT   5 Tier 5 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FAYOSIM TABLET TBDSPK 3MO [Quartette]   2 Tier 2 $0.00$0.00None
FEBUXOSTAT 40 MG TABLET [Uloric]   2 Tier 2 $0.00$0.00S
FEBUXOSTAT 80 MG TABLET [Uloric]   2 Tier 2 $0.00$0.00S
FELBAMATE 400 MG TABLET   2 Tier 2 $0.00$0.00None
FELBAMATE 600 MG TABLET [Felbatol]   2 Tier 2 $0.00$0.00None
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [Felbatol]   2 Tier 2 $0.00$0.00None
FELBATOL 400MG TABLET   4 Tier 4 $35.00N/ANone
FELBATOL 600 MG/5 ML SUSP   4 Tier 4 $35.00N/ANone
FELBATOL 600MG TABLET   4 Tier 4 $35.00N/ANone
FELDENE 10MG CAPSULE   4 Tier 4 $35.00N/ANone
FELDENE 20MG CAPSULE   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FELODIPINE ER 10 MG TABLET   1 Tier 1 $0.00$0.00None
FELODIPINE ER 2.5 MG TABLET ER 24H [Plendil]   1 Tier 1 $0.00$0.00None
FELODIPINE ER 5 MG TABLET   1 Tier 1 $0.00$0.00None
FEMARA 2.5MG TABLET   4 Tier 4 $35.00N/ANone
FEMHRT 2.5; 0.5ug/1; mg/1 72 CARTON in 1 CASE / 5 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 2   4 Tier 4 $35.00N/ANone
FEMRING 0.05 MG/DAY VAGINAL RING   4 Tier 4 $35.00N/AS
FEMRING 0.10 MG/DAY VAGINAL RING   4 Tier 4 $35.00N/AS
FEMYNOR 28 TABLET [VyLibra]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 134MG CAPSULE [LIPOFEN]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 145 MG TABLET [Tricor]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 150 MG CAPSULE [LIPOFEN]   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENOFIBRATE 160 MG TABLET [LIPOFEN]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 200 MG CAPSULE [LIPOFEN]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 48 MG TABLET [Tricor]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 50 MG CAPSULE [LIPOFEN]   4 Tier 4 $35.00N/ANone
FENOFIBRATE 50 MG ORAL CAPSULE [LIPOFEN]   4 Tier 4 $35.00N/ANone
FENOFIBRATE 54 MG 90 TABLET BOTTLE [LIPOFEN]   2 Tier 2 $0.00$0.00None
FENOFIBRATE 67MG CAPSULE [LIPOFEN]   2 Tier 2 $0.00$0.00None
FENOFIBRIC ACID DR 135 MG CAPSULE [TRILIPIX]   2 Tier 2 $0.00$0.00None
FENOFIBRIC ACID DR 45 MG CAPSULE DR [Trilipix]   2 Tier 2 $0.00$0.00None
FENTANYL 100 MCG/HR PATCH TD72 [Duragesic]   2 Tier 2 $0.00$0.00Q:10
/30Days
FENTANYL 12 MCG/HR PATCH TD72 [Duragesic]   2 Tier 2 $0.00$0.00Q:10
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENTANYL 25 MCG/HR PATCH TD72 [Duragesic]   2 Tier 2 $0.00$0.00Q:10
/30Days
FENTANYL 50 MCG/HR PATCH TD72 [Duragesic]   2 Tier 2 $0.00$0.00Q:10
/30Days
FENTANYL 75 MCG/HR PATCH TD72 [Duragesic]   2 Tier 2 $0.00$0.00Q:10
/30Days
FENTANYL CIT 100 MCG BUCCAL TABLET EFF [Fentora]   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTANYL CIT 200 MCG BUCCAL TABLET EFF [Fentora]   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTANYL CIT 400 MCG BUCCAL TABLET EFF [Fentora]   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTANYL CIT 600 MCG BUCCAL TABLET EFF [Fentora]   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTANYL CIT 800 MCG BUCCAL TABLET EFF [Fentora]   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTANYL CIT OTFC 1,200 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
FENTANYL CIT OTFC 1,600 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
FENTANYL CITRATE OTFC 200 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FENTANYL CITRATE OTFC 400 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
FENTANYL CITRATE OTFC 600 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
FENTANYL CITRATE OTFC 800 MCG LOZENGE HD [Actiq]   2 Tier 2 $0.00$0.00P Q:120
/30Days
FENTORA TABLET 100MCG   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTORA TABLET 200MCG   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTORA TABLET 400MCG   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTORA TABLET 600MCG   4 Tier 4 $35.00N/AP Q:120
/30Days
FENTORA TABLET 800MCG   4 Tier 4 $35.00N/AP Q:120
/30Days
FERRIPROX 1,000 MG TABLET   5 Tier 5 33%N/AP
FERRIPROX 100 MG/ML SOLUTION   5 Tier 5 33%N/AP
FERRIPROX 500 MG TABLET   5 Tier 5 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FETZIMA 20-40 MG TITRATION PAK   4 Tier 4 $35.00N/AS Q:30
/30Days
FETZIMA ER 120 MG CAPSULE   4 Tier 4 $35.00N/AS Q:30
/30Days
FETZIMA ER 20 MG CAPSULE   4 Tier 4 $35.00N/AS Q:30
/30Days
FETZIMA ER 40 MG CAPSULE   4 Tier 4 $35.00N/AS Q:30
/30Days
FETZIMA ER 80 MG CAPSULE   4 Tier 4 $35.00N/AS Q:30
/30Days
FEXMID 7.5 MG TABLET   4 Tier 4 $35.00N/ANone
FIASP 100 UNIT/ML FLEXTOUCH INSULIN PEN   3 Tier 3 $0.00N/ANone
FIASP 100 UNIT/ML VIAL   3 Tier 3 $0.00N/AP
FIASP PENFILL 100 UNIT/ML CART CARTRIDGE   3 Tier 3 $0.00N/ANone
FINACEA 15% FOAM   3 Tier 3 $0.00N/ANone
FINASTERIDE 5 MG TABLET [Proscar]   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FIRMAGON 2 X 120 MG KIT   3 Tier 3 $0.00N/AP
FIRMAGON 80 MG KIT   3 Tier 3 $0.00N/AP
FIRVANQ 25 MG/ML SOLUTION SOLN RECON   2 Tier 2 $0.00$0.00None
FIRVANQ 50 MG/ML SOLUTION RECON   2 Tier 2 $0.00$0.00None
FLAC OTIC OIL 0.01% EAR DROPS [Flac]   2 Tier 2 $0.00$0.00None
FLAGYL 250MG TABLET (100 CT)   4 Tier 4 $35.00N/ANone
FLAGYL 375MG CAPSULE   4 Tier 4 $35.00N/ANone
FLAREX 0.1% EYE DROPS   4 Tier 4 $35.00N/ANone
FLAVOXATE 100 MG TABLET 100   2 Tier 2 $0.00$0.00None
FLEBOGAMMA DIF INJECTION   5 Tier 5 33%N/AP
FLECAINIDE ACETATE 100 MG TABLET [Tambocor]   2 Tier 2 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLECAINIDE ACETATE 150 MG TABLET [Tambocor]   2 Tier 2 $0.00$0.00None
FLECAINIDE ACETATE 50 MG TABLET [Tambocor]   2 Tier 2 $0.00$0.00None
FLECTOR 1.3% PATCH TD12   4 Tier 4 $35.00N/AP Q:60
/30Days
FLOMAX 0.4 MG CAPSULE   4 Tier 4 $35.00N/ANone
FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER   2 Tier 2 $0.00$0.00Q:60
/30Days
FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER   2 Tier 2 $0.00$0.00Q:60
/30Days
FLOVENT DISKUS POWDER 50MCG 60 CTR   2 Tier 2 $0.00$0.00Q:60
/30Days
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER   2 Tier 2 $0.00$0.00Q:24
/30Days
FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER   2 Tier 2 $0.00$0.00Q:24
/30Days
FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER   2 Tier 2 $0.00$0.00Q:21
/30Days
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [Diflucan]   2 Tier 2 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUCONAZOLE 100 MG TABLET [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCONAZOLE 150 MG TABLET [Diflucan]   1 Tier 1 $0.00$0.00None
FLUCONAZOLE 200 MG TABLET [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCONAZOLE 50 MG TABLET [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCONAZOLE-NACL 200 MG/100 ML PIGGYBACK [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCONAZOLE-NACL 400 MG/200 ML PIGGYBACK [Diflucan]   2 Tier 2 $0.00$0.00None
FLUCYTOSINE 250 MG CAPSULE [Ancobon]   2 Tier 2 $0.00$0.00None
FLUCYTOSINE 500 MG CAPSULE [Ancobon]   2 Tier 2 $0.00$0.00None
FLUDROCORTISONE 0.1 MG TABLET   2 Tier 2 $0.00$0.00None
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL   2 Tier 2 $0.00$0.00Q:50
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUOCINOLONE 0.01% CREAM (g)   2 Tier 2 $0.00$0.00None
FLUOCINOLONE 0.01% SCALP OIL [Derma-Smoothe/FS]   2 Tier 2 $0.00$0.00None
FLUOCINOLONE 0.01% SOLUTION [Synalar]   2 Tier 2 $0.00$0.00None
FLUOCINOLONE 0.025% CREAM (g) [Synalar]   2 Tier 2 $0.00$0.00None
FLUOCINOLONE 0.025% OINTMENT   2 Tier 2 $0.00$0.00None
FLUOCINOLONE OIL 0.01% EAR DROPS [Flac]   2 Tier 2 $0.00$0.00None
FLUOCINONIDE 0.05% GEL   2 Tier 2 $0.00$0.00None
FLUOCINONIDE 0.05% OINTMENT [Lidex]   2 Tier 2 $0.00$0.00None
FLUOCINONIDE 0.05% SOLUTION   2 Tier 2 $0.00$0.00None
FLUOCINONIDE-E 0.05% CREAM   2 Tier 2 $0.00$0.00None
Fluorometholone 0.1% drops   2 Tier 2 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUOROPLEX 1% CREAM (G)   4 Tier 4 $35.00N/ANone
FLUOROURACIL 0.5% CREAM   3 Tier 3 $0.00N/ANone
FLUOROURACIL 2% TOPICAL SOLUTION   3 Tier 3 $0.00N/ANone
FLUOROURACIL 5% CREAM (g) [Efudex]   1 Tier 1 $0.00$0.00None
FLUOROURACIL 5% TOPICAL SOLUTION   3 Tier 3 $0.00N/ANone
Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC   1 Tier 1 $0.00$0.00None
FLUOXETINE HCL 10 MG CAPSULE [Selfemra]   1 Tier 1 $0.00$0.00None
FLUOXETINE HCL 10 MG TABLET [Sarafem]   2 Tier 2 $0.00$0.00None
FLUOXETINE HCL 20 MG CAPSULE   1 Tier 1 $0.00$0.00None
FLUOXETINE HCL 20 MG TABLET [Sarafem]   2 Tier 2 $0.00$0.00None
FLUOXETINE HCL 40 MG CAPSULE [Prozac]   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUPHENAZINE 1 MG TABLET   1 Tier 1 $0.00$0.00None
FLUPHENAZINE 10 MG TABLET [Prolixin]   1 Tier 1 $0.00$0.00None
FLUPHENAZINE 2.5 MG TABLET   1 Tier 1 $0.00$0.00None
FLUPHENAZINE 2.5 MG/5 ML ELIX   2 Tier 2 $0.00$0.00None
FLUPHENAZINE 2.5MG/ML VIAL   3 Tier 3 $0.00N/ANone
FLUPHENAZINE 5 MG TABLET   1 Tier 1 $0.00$0.00None
FLUPHENAZINE 5MG/ML CONC   2 Tier 2 $0.00$0.00None
FLUPHENAZINE DEC 125 MG/5 ML VIAL [Prolixin Decanoate]   2 Tier 2 $0.00$0.00None
Flurandrenolide 0.05% Cream [Cordran]   2 Tier 2 $0.00$0.00None
Flurandrenolide 0.5 MG/ML Topical Lotion [Cordran]   2 Tier 2 $0.00$0.00None
Flurazepam Hydrochloride 15mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC   3 Tier 3 $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Flurazepam Hydrochloride 30mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC   3 Tier 3 $0.00N/ANone
FLURBIPROFEN 0.03% EYE DROPS [Ocufen]   1 Tier 1 $0.00$0.00None
Flurbiprofen 100mg/1 100 BOTTLE in 1 BOTTLE / 100 FILM COATED TABLETS in BOTTLE   1 Tier 1 $0.00$0.00None
FLUTAMIDE 125 MG CAPSULE   2 Tier 2 $0.00$0.00None
FLUTICASONE PROP 0.005% OINTMENT [Cutivate]   2 Tier 2 $0.00$0.00None
FLUTICASONE PROP 0.05% LOTION   2 Tier 2 $0.00$0.00P
Fluticasone Propionate 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE   2 Tier 2 $0.00$0.00None
FLUTICASONE PROPIONATE 50 MCG SPRAY SUSPENSION   1 Tier 1 $0.00$0.00Q:32
/30Days
FLUTICASONE-SALMETEROL 100-50 BLST W/DEV [Advair]   2 Tier 2 $0.00$0.00Q:60
/30Days
FLUTICASONE-SALMETEROL 113-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   2 Tier 2 $0.00$0.00Q:1
/30Days
FLUTICASONE-SALMETEROL 232-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   2 Tier 2 $0.00$0.00Q:1
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FLUTICASONE-SALMETEROL 250-50 BLST W/DEV [Advair]   2 Tier 2 $0.00$0.00Q:60
/30Days
FLUTICASONE-SALMETEROL 500-50 BLST W/DEV [Advair]   2 Tier 2 $0.00$0.00Q:60
/30Days
FLUTICASONE-SALMETEROL 55-14 [Advair Diskus, Advair HFA, AIRDUO RESPICLICK]   2 Tier 2 $0.00$0.00Q:1
/30Days
FLUVASTATIN ER 80 MG TABLET ER 24H [Lescol XL]   2 Tier 2 $0.00$0.00None
FLUVASTATIN SODIUM 20 MG CAPSULE [Lescol]   2 Tier 2 $0.00$0.00None
FLUVASTATIN SODIUM 40 MG CAPSULE [Lescol]   2 Tier 2 $0.00$0.00None
FLUVOXAMINE ER 100 MG CAPSULE   2 Tier 2 $0.00$0.00S
FLUVOXAMINE ER 150 MG CAPSULE   2 Tier 2 $0.00$0.00S
FLUVOXAMINE MALEATE 100 MG TABLET [Luvox]   1 Tier 1 $0.00$0.00None
FLUVOXAMINE MALEATE 25 MG TABLET [Luvox]   1 Tier 1 $0.00$0.00None
FLUVOXAMINE MALEATE 50 MG TABLET [Luvox]   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FML FORTE 0.25% EYE DROPS   4 Tier 4 $35.00N/ANone
FML LIQUIFILM 0.1% EYE DROP   4 Tier 4 $35.00N/ANone
FML S.O.P. 0.1% OINTMENT   4 Tier 4 $35.00N/ANone
FOCALIN 10MG TABLET   4 Tier 4 $35.00N/ANone
FOCALIN 2.5MG TABLET   4 Tier 4 $35.00N/ANone
FOCALIN 5MG TABLET   4 Tier 4 $35.00N/ANone
FOCALIN XR 10MG CAPSULE   4 Tier 4 $35.00N/ANone
FOCALIN XR 15MG CAPSULE   4 Tier 4 $35.00N/ANone
FOCALIN XR 20MG CAPSULE   4 Tier 4 $35.00N/ANone
Focalin XR 25mg EXTENDED RELEASE 100 CAPSULE BOTTLE   4 Tier 4 $35.00N/ANone
FOCALIN XR 30MG CAPSULES   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Focalin XR 35mg EXTENDED RELEASE 100 CAPSULE BOTTLE   4 Tier 4 $35.00N/ANone
Focalin XR 40mg EXTENDED RELEASE 100 CAPSULE BOTTLE   4 Tier 4 $35.00N/ANone
FOCALIN XR 5 MG CAPSULE   4 Tier 4 $35.00N/ANone
FONDAPARINUX 10 MG/0.8 ML SYRINGE [Arixtra]   2 Tier 2 $0.00$0.00None
FONDAPARINUX 2.5 MG/0.5 ML SYRINGE [Arixtra]   2 Tier 2 $0.00$0.00None
FONDAPARINUX 5 MG/0.4 ML SYRINGE [Arixtra]   2 Tier 2 $0.00$0.00None
FONDAPARINUX 7.5 MG/0.6 ML SYRINGE [Arixtra]   2 Tier 2 $0.00$0.00None
Fondaparinux sodium 10 MG per 0.8 ML Prefilled Syringe [Arixtra]   4 Tier 4 $35.00N/ANone
Fondaparinux sodium 2.5 MG in 0.5 ML Prefilled Syringe Prefilled Syringe [Arixtra]   4 Tier 4 $35.00N/ANone
Fondaparinux sodium 5 MG in 0.4 ML Prefilled Syringe [Arixtra]   4 Tier 4 $35.00N/ANone
Forteo 250ug/mL 1 SYRINGE per CARTON / 2.4 mL in 1 SYRINGE   5 Tier 5 33%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FOSAMAX 70MG TABLET   4 Tier 4 $35.00N/ANone
FOSAMPRENAVIR 700 MG TABLET [Lexiva]   5 Tier 5 33%N/ANone
FOSINOPRIL SODIUM 10 MG TABLET   1 Tier 1 $0.00$0.00None
FOSINOPRIL SODIUM 20 MG TABLET   1 Tier 1 $0.00$0.00None
FOSINOPRIL SODIUM 40 MG TABLET   1 Tier 1 $0.00$0.00None
FOSINOPRIL-HCTZ 10-12.5 MG TABLET [Monopril-HCT]   2 Tier 2 $0.00$0.00None
FOSINOPRIL-HCTZ 20-12.5 MG TABLET [Monopril-HCT]   2 Tier 2 $0.00$0.00None
FOSRENOL 1,000 MG POWDER PACK   3 Tier 3 $0.00N/ANone
FOSRENOL 750 MG POWDER PACKET   3 Tier 3 $0.00N/ANone
FRAGMIN 10,000 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 12,500 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FRAGMIN 15,000 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 18,000 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 2,500 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 5,000 UNITS SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 7,500 UNITS/0.3 ML SYRINGE   4 Tier 4 $35.00N/ANone
FRAGMIN 95,000 UNITS/3.8 ML VIAL   4 Tier 4 $35.00N/ANone
FREAMINE HBC INJECTION   4 Tier 4 $35.00N/AP
FULPHILA 6 MG/0.6 ML SYRINGE   5 Tier 5 33%N/ANone
FUROSEMIDE 10 MG/ML SOLUTION   2 Tier 2 $0.00$0.00None
FUROSEMIDE 100 MG/10 ML VIAL   2 Tier 2 $0.00$0.00None
Furosemide 10mg/mL 10 CARTON in 1 CONTAINER / 1 SYRINGE, PLASTIC in 1 CARTON / 4 mL in 1 SYRINGE, P   2 Tier 2 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FUROSEMIDE 20 MG TABLET   1 Tier 1 $0.00$0.00None
FUROSEMIDE 40 MG TABLET [Lasix]   1 Tier 1 $0.00$0.00None
FUROSEMIDE 40MG/5ML TUBEX   2 Tier 2 $0.00$0.00None
FUROSEMIDE 80 MG TABLET   1 Tier 1 $0.00$0.00None
FUZEON 90 MG VIAL   5 Tier 5 33%N/ANone
FYAVOLV 1 MG-5 MCG TABLET   2 Tier 2 $0.00$0.00None
FYCOMPA 0.5 MG/ML ORAL SUSP   4 Tier 4 $35.00N/AP
FYCOMPA 10 MG TABLET   4 Tier 4 $35.00N/AP
FYCOMPA 12 MG TABLET   4 Tier 4 $35.00N/AP
FYCOMPA 2 MG TABLET   4 Tier 4 $35.00N/AP
FYCOMPA 4 MG TABLET   4 Tier 4 $35.00N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
FYCOMPA 6 MG TABLET   4 Tier 4 $35.00N/AP
FYCOMPA 8 MG TABLET   4 Tier 4 $35.00N/AP

Chart Legend:

Below are a few notes to help you understand the above 2020 Medicare Part D SOLIS SPF 001 (HMO) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug or Medicare Advantage plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $435 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.
    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.

  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs.
    • Tier Number* - Some Part D drug plans exclude one or more drug tiers from the plan’s deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.

  • Cost Sharing - Copay / Coinsurance - This is what you will pay for formulary drugs in the Initial Coverage Phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $4020) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).

  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.


(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2020 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Medicare plan provider.








Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.