Q1GROUP LLC | Q1Medicare.com - a non-government resource for the Medicare community
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

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
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)
Benefit Details           
The SOLIS SPF 001 (HMO) (H0982-001-0)
Formulary Drugs Starting with the Letter B

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Bacitracin 500 unit/gm Eye Ointment   2 Tier 2 $0.00$0.00None
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT   2 Tier 2 $0.00$0.00None
BACLOFEN 10 MG TABLET   1 Tier 1 $0.00$0.00None
BACLOFEN 20 MG TABLET [Lioresal]   1 Tier 1 $0.00$0.00None
BACTRIM 400-80 MG TABLET   4 Tier 4 $35.00N/ANone
BACTRIM DS 800-160 MG TABLET   4 Tier 4 $35.00N/ANone
BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal]   2 Tier 2 $0.00$0.00None
BALVERSA 3 MG TABLET   5 Tier 5 33%N/AP Q:60
/30Days
BALVERSA 4 MG TABLET   5 Tier 5 33%N/AP Q:60
/30Days
BALVERSA 5 MG TABLET   5 Tier 5 33%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK   2 Tier 2 $0.00$0.00None
Banzel 200mg/1   3 Tier 3 $0.00N/ANone
BANZEL 400MG TABLET   3 Tier 3 $0.00N/ANone
Banzel 40mg/mL   3 Tier 3 $0.00N/ANone
BAQSIMI 3 MG SPRAY TWO PACK   3 Tier 3 $0.00N/AQ:2
/7Days
BARACLUDE 0.5MG TABLET   4 Tier 4 $35.00N/ANone
BARACLUDE 1MG TABLET   4 Tier 4 $35.00N/ANone
BAXDELA 450 MG TABLET   3 Tier 3 $0.00N/AP Q:60
/30Days
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL   3 Tier 3 $0.00N/ANone
BENAZEPRIL HCL 10 MG TABLET   1 Tier 1 $0.00$0.00None
BENAZEPRIL HCL 20 MG TABLET   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BENAZEPRIL HCL 40 MG TABLET   1 Tier 1 $0.00$0.00None
BENAZEPRIL HCL 5 MG TABLET   1 Tier 1 $0.00$0.00None
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT)   2 Tier 2 $0.00$0.00None
BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT]   2 Tier 2 $0.00$0.00None
BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT]   2 Tier 2 $0.00$0.00None
BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT]   2 Tier 2 $0.00$0.00None
BENICAR 20 MG TABLET   4 Tier 4 $35.00N/ANone
BENICAR 40 MG TABLET   4 Tier 4 $35.00N/ANone
BENICAR 5MG TABLET   4 Tier 4 $35.00N/ANone
BENICAR HCT 20-12.5 MG TABLET   4 Tier 4 $35.00N/ANone
BENICAR HCT 40-25 MG TABLET   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BENICAR HCT TABLET 12.5-40MG (30 CT)   4 Tier 4 $35.00N/ANone
BENLYSTA 200 MG/ML AUTOINJECT   5 Tier 5 33%N/AP Q:4
/28Days
BENLYSTA 200 MG/ML SYRINGE   5 Tier 5 33%N/AP Q:4
/28Days
BENZACLIN GEL 50G PUMP   4 Tier 4 $35.00N/ANone
BENZAMYCIN GEL   4 Tier 4 $35.00N/ANone
BENZNIDAZOLE 100 MG TABLET   3 Tier 3 $0.00N/AP
BENZNIDAZOLE 12.5 MG TABLET   3 Tier 3 $0.00N/AP
BENZTROPINE MES 0.5 MG TABLET [Cogentin]   1 Tier 1 $0.00$0.00None
BENZTROPINE MES 1 MG TABLET [Cogentin]   1 Tier 1 $0.00$0.00None
BENZTROPINE MES 2 MG TABLET [Cogentin]   1 Tier 1 $0.00$0.00None
BEPREVE 1.5% EYE DROPS   4 Tier 4 $35.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BERINERT 500 UNIT KIT   5 Tier 5 33%N/AP
BESER 0.05% LOTION [Cutivate]   2 Tier 2 $0.00$0.00P
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP 0.05% LOTION   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP 0.05% OINTMENT   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak]   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP AUG 0.05% GEL   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP AUG 0.05% LOTION   2 Tier 2 $0.00$0.00None
BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene]   2 Tier 2 $0.00$0.00None
BETAMETHASONE VA 0.1% CREAM   2 Tier 2 $0.00$0.00None
BETAMETHASONE VALER 0.12% FOAM [Luxiq Foam]   2 Tier 2 $0.00$0.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BETAMETHASONE VALERATE 0.1% LOTION   2 Tier 2 $0.00$0.00None
BETAMETHASONE VALERATE OINTMENT USP   2 Tier 2 $0.00$0.00None
BETAPACE AF 120 MG TABLET   4 Tier 4 $35.00N/ANone
BETAPACE AF 160 MG TABLET   4 Tier 4 $35.00N/ANone
BETAPACE AF 80 MG TABLET   4 Tier 4 $35.00N/ANone
BETAXOLOL 10 MG TABLET   1 Tier 1 $0.00$0.00None
BETAXOLOL 20 MG TABLET   1 Tier 1 $0.00$0.00None
Betaxolol 5 MG/ML Ophthalmic Solution   2 Tier 2 $0.00$0.00None
BETHANECHOL 10 MG TABLET   1 Tier 1 $0.00$0.00None
BETHANECHOL 25 MG TABLET   1 Tier 1 $0.00$0.00None
BETHANECHOL 5 MG TABLET   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BETHANECHOL 50 MG TABLET   1 Tier 1 $0.00$0.00None
BETIMOL 0.25% EYE DROPS   4 Tier 4 $35.00N/ANone
BETIMOL 0.5% EYE DROPS   3 Tier 3 $0.00N/ANone
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT   4 Tier 4 $35.00N/ANone
BEXAROTENE 75 MG CAPSULE [Targretin]   5 Tier 5 33%N/AP
BEXSERO PREFILLED SYRINGE   3 Tier 3 $0.00N/ANone
BICALUTAMIDE 50 MG TABLET   1 Tier 1 $0.00$0.00None
BICILL LA PFS 600MU 1ML PED   3 Tier 3 $0.00N/ANone
BICILLIN C-R 1.2MM UNITS SYRINGE 2ML x 10   3 Tier 3 $0.00N/ANone
BICILLIN C-R 900/300 SYRINGE 2ML x 10   3 Tier 3 $0.00N/ANone
BICILLIN LA PFS 1200MU 2ML   3 Tier 3 $0.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BICILLIN LA. 600000UNIT/ML 1ML   3 Tier 3 $0.00N/ANone
BIDIL TABLET   3 Tier 3 $0.00N/ANone
BIKTARVY 50-200-25 MG TABLET   5 Tier 5 33%N/ANone
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE   4 Tier 4 $35.00N/ANone
BIMATOPROST 0.03% EYE DROPS [Lumigan]   2 Tier 2 $0.00$0.00Q:5
/30Days
BISOPROLOL FUMARATE 10 MG TABLET   1 Tier 1 $0.00$0.00None
BISOPROLOL FUMARATE 5 MG TABLET   1 Tier 1 $0.00$0.00None
BISOPROLOL-HCTZ 10-6.25 MG TABLET   1 Tier 1 $0.00$0.00None
BISOPROLOL-HCTZ 2.5-6.25 MG TABLET   1 Tier 1 $0.00$0.00None
BISOPROLOL-HCTZ 5-6.25 MG TABLET   1 Tier 1 $0.00$0.00None
BIVIGAM 10% VIAL [Panzyga]   5 Tier 5 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BLEPH-10 10% EYE DROPS   4 Tier 4 $35.00N/ANone
BLEPHAMIDE 10-0.2% EYE OINTMENT   4 Tier 4 $35.00N/ANone
BLEPHAMIDE EYE DROPS   4 Tier 4 $35.00N/ANone
BLISOVI 24 FE TABLET [Tarina Fe 1/20]   2 Tier 2 $0.00$0.00None
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30]   2 Tier 2 $0.00$0.00None
BONIVA 150 MG TABLET   4 Tier 4 $35.00N/AQ:1
/30Days
BOOSTRIX TDAP VACCINE SYRINGE   3 Tier 3 $0.00N/ANone
BOOSTRIX TDAP VACCINE VIAL   3 Tier 3 $0.00N/ANone
BOSENTAN 125 MG TABLET [Tracleer]   5 Tier 5 33%N/AP Q:60
/30Days
BOSENTAN 62.5 MG TABLET [Tracleer]   5 Tier 5 33%N/AP Q:60
/30Days
BOSULIF 100 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
BOSULIF 400 MG TABLET   5 Tier 5 33%N/AP
BOSULIF 500 MG TABLET   5 Tier 5 33%N/AP
BRAFTOVI 75 MG CAPSULE   5 Tier 5 33%N/AP Q:180
/30Days
BREO ELLIPTA 100-25 MCG INH   3 Tier 3 $0.00N/AQ:60
/30Days
BREO ELLIPTA 200-25 MCG INH   3 Tier 3 $0.00N/AQ:60
/30Days
BRIELLYN TABLET   2 Tier 2 $0.00$0.00None
BRILINTA 60 MG TABLET   4 Tier 4 $35.00N/ANone
BRILINTA 90mg/1 60 TABLET BOTTLE   4 Tier 4 $35.00N/ANone
BRIMONIDINE 0.2% EYE DROPS [Alphagan]   2 Tier 2 $0.00$0.00None
BRIMONIDINE TARTRATE 0.15% DROPS   2 Tier 2 $0.00$0.00None
BRIVIACT 10 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
BRIVIACT 10 MG/ML ORAL SOLUTION   4 Tier 4 $35.00N/AP
BRIVIACT 100 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
BRIVIACT 25 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
BRIVIACT 50 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
BRIVIACT 75 MG TABLET   4 Tier 4 $35.00N/AP Q:60
/30Days
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom]   3 Tier 3 $0.00N/ANone
BROMOCRIPTINE 2.5 MG TABLET [Parlodel]   2 Tier 2 $0.00$0.00None
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel]   2 Tier 2 $0.00$0.00None
BROVANA 15MCG/2ML VIAL NEBULIZER   4 Tier 4 $35.00N/AP
BRUKINSA 80 MG CAPSULE   5 Tier 5 33%N/AP Q:120
/30Days
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   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
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   2 Tier 2 $0.00$0.00P Q:120
/30Days
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort]   2 Tier 2 $0.00$0.00P Q:120
/30Days
BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC]   2 Tier 2 $0.00$0.00None
BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS]   2 Tier 2 $0.00$0.00P Q:30
/30Days
BUMETANIDE 0.5 MG TABLET   2 Tier 2 $0.00$0.00None
BUMETANIDE 1 MG TABLET   2 Tier 2 $0.00$0.00None
BUMETANIDE 1 MG/4 ML VIAL   2 Tier 2 $0.00$0.00None
BUMETANIDE 2 MG TABLET [Bumex]   2 Tier 2 $0.00$0.00None
BUPHENYL POWDER   5 Tier 5 33%N/ANone
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone]   1 Tier 1 $0.00$0.00None
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone]   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone]   1 Tier 1 $0.00$0.00None
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone]   1 Tier 1 $0.00$0.00None
BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone]   1 Tier 1 $0.00$0.00None
BUPRENORPHINE 10 MCG/HR PATCH [Butrans]   2 Tier 2 $0.00$0.00Q:4
/28Days
BUPRENORPHINE 15 MCG/HR PATCH [Butrans]   2 Tier 2 $0.00$0.00Q:4
/28Days
BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex]   1 Tier 1 $0.00$0.00None
BUPRENORPHINE 20 MCG/HR PATCH [Butrans]   2 Tier 2 $0.00$0.00Q:4
/28Days
BUPRENORPHINE 5 MCG/HR PATCH [Butrans]   2 Tier 2 $0.00$0.00Q:4
/28Days
BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans]   2 Tier 2 $0.00$0.00Q:4
/28Days
BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex]   1 Tier 1 $0.00$0.00None
BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone]   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPROPION HCL 100 MG TABLET   1 Tier 1 $0.00$0.00None
BUPROPION HCL 75 MG TABLET   1 Tier 1 $0.00$0.00None
BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR]   1 Tier 1 $0.00$0.00None
BUPROPION HCL SR 150 MG TABLET   1 Tier 1 $0.00$0.00None
BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR]   1 Tier 1 $0.00$0.00None
BUPROPION HCL SR 200 MG TABLET   1 Tier 1 $0.00$0.00None
BUPROPION HCL XL 150 MG TABLET   1 Tier 1 $0.00$0.00None
BUPROPION HCL XL 300 MG TABLET   1 Tier 1 $0.00$0.00None
BUSPIRONE HCL 15 MG TABLET   1 Tier 1 $0.00$0.00None
BUSPIRONE HCL 30 MG TABLET   1 Tier 1 $0.00$0.00None
BUSPIRONE HCL 5 MG TABLET   1 Tier 1 $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUSPIRONE HCL 7.5 MG TABLET   1 Tier 1 $0.00$0.00None
BUSPIRONE HYDROCHLORIDE 10 MG TABLET   1 Tier 1 $0.00$0.00None
BUTORPHANOL 10 MG/ML SPRAY [Stadol NS]   2 Tier 2 $0.00$0.00Q:10
/30Days
BYDUREON 2 MG PEN INJECT   3 Tier 3 $0.00N/AQ:4
/28Days
BYDUREON BCISE 2 MG AUTOINJECT   3 Tier 3 $0.00N/AQ:3
/28Days
BYETTA 10 MCG DOSE PEN INJ   4 Tier 4 $35.00N/AQ:2
/30Days
BYETTA 5 MCG DOSE PEN INJ   4 Tier 4 $35.00N/AQ:1
/30Days
Bystolic 10mg/1 30 TABLET BOTTLE   3 Tier 3 $0.00N/ANone
Bystolic 2.5mg/1 30 TABLET BOTTLE   3 Tier 3 $0.00N/ANone
BYSTOLIC 20 MG TABLET   3 Tier 3 $0.00N/ANone
Bystolic 5mg 30 TABLET BOTTLE   3 Tier 3 $0.00N/ANone

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.