2021 Medicare Part D Plan Formulary Information |
UPMC for Life HMO Rx (HMO) (H3907-029-0)
Benefit Details
![Email Prescription and/or Health Benefit details for UPMC for Life HMO Rx (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) This plan covers select insulin pay $35 copay.
See individual insulin cost-sharing below. |
The UPMC for Life HMO Rx (HMO) (H3907-029-0) Formulary Drugs Starting with the Letter O in Clearfield County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $81.00 Deductible: $0 |
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 PA cover OCALIVA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
OCALIVA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OCALIVA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
OCELLA 3MG/0.03MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OCELLA 3MG/0.03MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
OCTAGAM 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover OCTAGAM 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
OCTAGAM 5% VIAL ![Compare how all Medicare Part D PDP plans in PA cover OCTAGAM 5% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
OCTREOTIDE 1,000 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE 1,000 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
OCTREOTIDE ACET 0.05 MG/ML VL ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACET 0.05 MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OCTREOTIDE ACET 200 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACET 200 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
OCTREOTIDE ACET 500 MCG/ML VL ![Compare how all Medicare Part D PDP plans in PA cover OCTREOTIDE ACET 500 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
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 PA cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ODACTRA 12 SQ-HDM SUBLIGUAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover ODACTRA 12 SQ-HDM SUBLIGUAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
ODEFSEY TABLET ![Compare how all Medicare Part D PDP plans in PA cover ODEFSEY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ODOMZO 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ODOMZO 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
OFEV 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OFEV 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
OFEV 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OFEV 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
OFLOXACIN 0.3 % DRP ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 0.3 % DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OFLOXACIN 0.3% EAR DROPS [Floxin] ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 0.3% EAR DROPS [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
OFLOXACIN 300 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 300 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OFLOXACIN 400 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in PA cover OFLOXACIN 400 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLANZAPINE 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE 10 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLANZAPINE 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
OLANZAPINE 2.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 2.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
OLANZAPINE 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
OLANZAPINE 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
OLANZAPINE 7.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE 7.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days |
OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days |
OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in PA cover OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in PA cover OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OLMSRTN-AMLDPN-HCTZ 20-5-12.5 TABLET [Tribenzor] ![Compare how all Medicare Part D PDP plans in PA cover OLMSRTN-AMLDPN-HCTZ 20-5-12.5 TABLET [Tribenzor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLMSRTN-AMLDPN-HCTZ 40-10-12.5 TABLET [Tribenzor] ![Compare how all Medicare Part D PDP plans in PA cover OLMSRTN-AMLDPN-HCTZ 40-10-12.5 TABLET [Tribenzor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLMSRTN-AMLDPN-HCTZ 40-10-25MG TABLET [Tribenzor] ![Compare how all Medicare Part D PDP plans in PA cover OLMSRTN-AMLDPN-HCTZ 40-10-25MG TABLET [Tribenzor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLMSRTN-AMLDPN-HCTZ 40-5-12.5 TABLET [Tribenzor] ![Compare how all Medicare Part D PDP plans in PA cover OLMSRTN-AMLDPN-HCTZ 40-5-12.5 TABLET [Tribenzor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLMSRTN-AMLDPN-HCTZ 40-5-25 MG TABLET [Tribenzor] ![Compare how all Medicare Part D PDP plans in PA cover OLMSRTN-AMLDPN-HCTZ 40-5-25 MG TABLET [Tribenzor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLOPATADINE HCL 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover OLOPATADINE HCL 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
OLOPATADINE HCL 0.2% EYE DROPS [Pataday] ![Compare how all Medicare Part D PDP plans in PA cover OLOPATADINE HCL 0.2% EYE DROPS [Pataday].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OLUMIANT 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OLUMIANT 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
OLUMIANT 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OLUMIANT 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza] ![Compare how all Medicare Part D PDP plans in PA cover OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in PA cover OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
ONDANSETRON 4 MG/5 ML SOLUTION [Zofran] ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON 4 MG/5 ML SOLUTION [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:900 /30Days |
ONDANSETRON HCL 24 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HCL 24 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
ONDANSETRON HCL 4 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HCL 4 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | P Q:90 /30Days |
ONDANSETRON HCL 8 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON HCL 8 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | P Q:90 /30Days |
ONDANSETRON ODT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON ODT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:90 /30Days |
ONDANSETRON ODT 8 MG TABLET RAPDIS [Zofran ODT] ![Compare how all Medicare Part D PDP plans in PA cover ONDANSETRON ODT 8 MG TABLET RAPDIS [Zofran ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:90 /30Days |
ONGENTYS 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ONGENTYS 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
ONGENTYS 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ONGENTYS 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
ONUREG 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONUREG 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:14 /28Days |
ONUREG 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ONUREG 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:14 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPSUMIT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OPSUMIT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ORALAIR 300 IR SUBLINGUAL TAB ![Compare how all Medicare Part D PDP plans in PA cover ORALAIR 300 IR SUBLINGUAL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
ORENCIA 125 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ORENCIA 125 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.4 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in PA 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 |
Specialty Tier |
33% | N/A | P Q:2 /28Days |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.7 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in PA 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 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
ORENCIA CLICKJECT 125 MG/ML ![Compare how all Medicare Part D PDP plans in PA cover ORENCIA CLICKJECT 125 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ORENITRAM ER 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
ORENITRAM ER 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ORENITRAM ER 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ORENITRAM ER 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORENITRAM ER 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
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 PA cover ORFADIN 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ORFADIN 4 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover ORFADIN 4 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ORGOVYX 120 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORGOVYX 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /28Days |
ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ ![Compare how all Medicare Part D PDP plans in PA cover ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:56 /28Days |
ORILISSA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORILISSA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ORILISSA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORILISSA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
ORKAMBI 100 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORKAMBI 100 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:112 /28Days |
ORKAMBI 100-125 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in PA cover ORKAMBI 100-125 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:56 /28Days |
ORKAMBI 150-188 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in PA cover ORKAMBI 150-188 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:56 /28Days |
ORKAMBI 200 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ORKAMBI 200 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:112 /28Days |
ORLADEYO 110 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ORLADEYO 110 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORLADEYO 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ORLADEYO 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
ORPHENADRINE ER 100 MG TABLET [Norflex] ![Compare how all Medicare Part D PDP plans in PA cover ORPHENADRINE ER 100 MG TABLET [Norflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ORSYTHIA-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in PA cover ORSYTHIA-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu] ![Compare how all Medicare Part D PDP plans in PA cover OSELTAMIVIR 6 MG/ML SUSPENSION [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:525 /180Days |
OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in PA cover OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:84 /180Days |
OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in PA cover OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:42 /180Days |
OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in PA cover OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:42 /180Days |
OTEZLA 28 DAY STARTER PACK TAB DS PK ![Compare how all Medicare Part D PDP plans in PA cover OTEZLA 28 DAY STARTER PACK TAB DS PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:110 /365Days |
OTEZLA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OTEZLA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
OTREXUP 10 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 10 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OTREXUP 12.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 12.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OTREXUP 15 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 15 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OTREXUP 17.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 17.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OTREXUP 20 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 20 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OTREXUP 22.5 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 22.5 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OTREXUP 25 MG/0.4 ML AUTO-INJ ![Compare how all Medicare Part D PDP plans in PA cover OTREXUP 25 MG/0.4 ML AUTO-INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:2 /28Days |
OXACILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXACILLIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 1GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXACILLIN 2 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 2 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in PA cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXANDROLONE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXANDROLONE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXANDROLONE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXANDROLONE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P |
OXAPROZIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXAPROZIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXAZEPAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OXAZEPAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:120 /30Days |
OXAZEPAM 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OXAZEPAM 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:120 /30Days |
OXAZEPAM 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover OXAZEPAM 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:120 /30Days |
OXBRYTA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXBRYTA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
OXCARBAZEPINE 150 MG TABLET [Trileptal] ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 150 MG TABLET [Trileptal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXCARBAZEPINE 300 MG TABLET [Trileptal] ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 300 MG TABLET [Trileptal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
OXCARBAZEPINE 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover OXCARBAZEPINE 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXERVATE 0.002% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover OXERVATE 0.002% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:112 /365Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYBUTYNIN 5 MG TABLET [Ditropan] ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN 5 MG TABLET [Ditropan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
OXYBUTYNIN 5 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN 5 MG/5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
OXYBUTYNIN CL ER 10 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN CL ER 10 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXYBUTYNIN CL ER 15 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN CL ER 15 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in PA cover OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
OXYCODON-ACETAMINOPHEN 7.5-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODON-ACETAMINOPHEN 7.5-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:360 /30Days |
OXYCODONE HCL 10 MG TABLET [Dazidox] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 10 MG TABLET [Dazidox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days |
OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYCODONE HCL 15 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 15 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days |
OXYCODONE HCL 20 MG TABLET [Roxicodone] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 20 MG TABLET [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days |
OXYCODONE HCL 30 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 30 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL 5 MG CAPSULE [OxyIR] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5 MG CAPSULE [OxyIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYCODONE HCL 5 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:180 /30Days |
OXYCODONE HCL 5 MG/5 ML SOLUTION [Roxicodone] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE HCL 5 MG/5 ML SOLUTION [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:900 /30Days |
OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:360 /30Days |
OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:360 /30Days |
OXYCODONE-ACETAMINOPHN 2.5-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in PA cover OXYCODONE-ACETAMINOPHN 2.5-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:360 /30Days |
OXYMORPHONE HCL 10 MG TABLET [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL 10 MG TABLET [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYMORPHONE HCL 5 MG TABLET [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL 5 MG TABLET [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
OXYMORPHONE HCL ER 10 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 10 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYMORPHONE HCL ER 15 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 15 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYMORPHONE HCL ER 30 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 30 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in PA cover OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
OZEMPIC 0.25-0.5 MG DOSE PEN ![Compare how all Medicare Part D PDP plans in PA cover OZEMPIC 0.25-0.5 MG DOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:2 /28Days |
OZEMPIC 1 MG DOSE PEN ![Compare how all Medicare Part D PDP plans in PA cover OZEMPIC 1 MG DOSE PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:3 /28Days |
OZEMPIC 1 MG/DOSE (4 MG/3 ML) PEN INJECTOR ![Compare how all Medicare Part D PDP plans in PA cover OZEMPIC 1 MG/DOSE (4 MG/3 ML) PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $20.00 | Q:3 /28Days |