2021 Medicare Part D Plan Formulary Information |
Triple S Platino Ultra (HMO D-SNP) (H5774-025-0)
Benefit Details
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The Triple S Platino Ultra (HMO D-SNP) (H5774-025-0) Formulary Drugs Starting with the Letter M in Guaynabo County, PR: CMS MA Region 30 which includes: PR Plan Monthly Premium: $0.00 Deductible: $445 |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in PR cover M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
MAGNESIUM SULFATE 50% VIAL ![Compare how all Medicare Part D PDP plans in PR cover MAGNESIUM SULFATE 50% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | P |
MARPLAN 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PR cover MARPLAN 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
MATULANE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MATULANE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
MAVYRET 100-40 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MAVYRET 100-40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MAYZENT 0.25 MG STARTER PACK TABLET DS PK ![Compare how all Medicare Part D PDP plans in PR cover MAYZENT 0.25 MG STARTER PACK TABLET DS PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MAYZENT 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MAYZENT 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MAYZENT 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MAYZENT 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MECLIZINE 12.5 MG TABLET [Antivert] ![Compare how all Medicare Part D PDP plans in PR cover MECLIZINE 12.5 MG TABLET [Antivert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MECLIZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MECLIZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEDROXYPROGESTERONE 10 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in PR cover MEDROXYPROGESTERONE 10 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEDROXYPROGESTERONE 150 MG/ML SYRINGE [Depo-Provera] ![Compare how all Medicare Part D PDP plans in PR cover MEDROXYPROGESTERONE 150 MG/ML SYRINGE [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:1 /90Days |
MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera] ![Compare how all Medicare Part D PDP plans in PR cover MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:1 /90Days |
MEDROXYPROGESTERONE 2.5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in PR cover MEDROXYPROGESTERONE 2.5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEDROXYPROGESTERONE 5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in PR cover MEDROXYPROGESTERONE 5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEFLOQUINE HCL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEFLOQUINE HCL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MEGESTROL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEGESTROL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEGESTROL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEGESTROL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEGESTROL ACET 40 MG/ML ORAL SUSPENSION [Megace] ![Compare how all Medicare Part D PDP plans in PR cover MEGESTROL ACET 40 MG/ML ORAL SUSPENSION [Megace].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEKINIST 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEKINIST 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MEKINIST 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEKINIST 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEKTOVI 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MEKTOVI 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MELOXICAM 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MELOXICAM 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MELOXICAM 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MELOXICAM 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEMANTINE 5-10 MG TITRATION PK [Namenda Titration] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE 5-10 MG TITRATION PK [Namenda Titration].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEMANTINE HCL 10 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL 10 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL 2 MG/ML SOLUTION [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEMANTINE HCL 5 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL 5 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in PR cover MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL ![Compare how all Medicare Part D PDP plans in PR cover Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
MENVEO A-C-Y-W-135-DIP VIAL ![Compare how all Medicare Part D PDP plans in PR cover MENVEO A-C-Y-W-135-DIP VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
MEPERIDINE 50 MG/ML VIAL [Demerol] ![Compare how all Medicare Part D PDP plans in PR cover MEPERIDINE 50 MG/ML VIAL [Demerol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MERCAPTOPURINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MERCAPTOPURINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MEROPENEM IV 500 MG VIAL [Merrem] ![Compare how all Medicare Part D PDP plans in PR cover MEROPENEM IV 500 MG VIAL [Merrem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MESALAMINE 1,000 MG SUPP.RECT [Canasa] ![Compare how all Medicare Part D PDP plans in PR cover MESALAMINE 1,000 MG SUPP.RECT [Canasa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MESALAMINE 4 GM/60 ML ENEMA ![Compare how all Medicare Part D PDP plans in PR cover MESALAMINE 4 GM/60 ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol] ![Compare how all Medicare Part D PDP plans in PR cover MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MESNEX 400MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MESNEX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
METFORMIN HCL 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
METFORMIN HCL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METFORMIN HCL 500 MG/5 ML SOLUTION [Riomet] ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL 500 MG/5 ML SOLUTION [Riomet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
METFORMIN HCL 850 MG TABLET [Glucophage] ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL 850 MG TABLET [Glucophage].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
METFORMIN HCL ER 500 MG TABLET ER 24H [Prozac] ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL ER 500 MG TABLET ER 24H [Prozac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR] ![Compare how all Medicare Part D PDP plans in PR cover METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
METHAZOLAMIDE 25 MG TABLET [Neptazane] ![Compare how all Medicare Part D PDP plans in PR cover METHAZOLAMIDE 25 MG TABLET [Neptazane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHIMAZOLE 10 MG TABLET [Tapazole] ![Compare how all Medicare Part D PDP plans in PR cover METHIMAZOLE 10 MG TABLET [Tapazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHIMAZOLE 5 MG TABLET [Tapazole] ![Compare how all Medicare Part D PDP plans in PR cover METHIMAZOLE 5 MG TABLET [Tapazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHOTREXATE 2.5 MG TABLET [Rheumatrex] ![Compare how all Medicare Part D PDP plans in PR cover METHOTREXATE 2.5 MG TABLET [Rheumatrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHOTREXATE 50 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover METHOTREXATE 50 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | P |
METHOTREXATE 50 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PR cover METHOTREXATE 50 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
Methoxsalen 10 mg Capsule [8-MOP] ![Compare how all Medicare Part D PDP plans in PR cover Methoxsalen 10 mg Capsule [8-MOP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHSCOPOLAMINE BROM 2.5 MG TABLET [Pamine] ![Compare how all Medicare Part D PDP plans in PR cover METHSCOPOLAMINE BROM 2.5 MG TABLET [Pamine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLDOPA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METHYLDOPA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
METHYLDOPA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METHYLDOPA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
METHYLPHENIDATE 10 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE 10 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPHENIDATE 10 MG/5 ML SOLUTION [Methylin] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE 10 MG/5 ML SOLUTION [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPHENIDATE 20 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE 20 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPHENIDATE 5 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE 5 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHYLPHENIDATE 5 MG/5 ML SOLUTION [Methylin] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE 5 MG/5 ML SOLUTION [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPHENIDATE ER(CD) 10MG CAPSULE CPBP 30-70 [Ritalin LA] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPHENIDATE ER(CD) 10MG CAPSULE CPBP 30-70 [Ritalin LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METHYLPREDNISOLONE 16 MG TABLET [Medrol Dosepak] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPREDNISOLONE 16 MG TABLET [Medrol Dosepak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPREDNISOLONE 32 MG TABLET [Medrol] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPREDNISOLONE 32 MG TABLET [Medrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHYLPREDNISOLONE 4 MG DOSEPK ![Compare how all Medicare Part D PDP plans in PR cover METHYLPREDNISOLONE 4 MG DOSEPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHYLPREDNISOLONE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METHYLPREDNISOLONE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METHYLPREDNISOLONE 8 MG TABLET [Medrol] ![Compare how all Medicare Part D PDP plans in PR cover METHYLPREDNISOLONE 8 MG TABLET [Medrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PR cover Metoclopramide 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOCLOPRAMIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METOCLOPRAMIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOCLOPRAMIDE 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover METOCLOPRAMIDE 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOLAZONE 10 MG TABLET [Zaroxolyn] ![Compare how all Medicare Part D PDP plans in PR cover METOLAZONE 10 MG TABLET [Zaroxolyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOLAZONE 2.5 MG TABLET [Zaroxolyn] ![Compare how all Medicare Part D PDP plans in PR cover METOLAZONE 2.5 MG TABLET [Zaroxolyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOLAZONE 5 MG TABLET [Zaroxolyn] ![Compare how all Medicare Part D PDP plans in PR cover METOLAZONE 5 MG TABLET [Zaroxolyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOPROLOL SUCC ER 100 MG TABLET ER 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL SUCC ER 100 MG TABLET ER 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL SUCC ER 200 MG TABLET ER 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL SUCC ER 200 MG TABLET ER 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
METOPROLOL SUCC ER 25 MG TABLET ER 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL SUCC ER 25 MG TABLET ER 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | Q:60 /30Days |
METOPROLOL SUCC ER 50 MG TABLET ER 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL SUCC ER 50 MG TABLET ER 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | Q:60 /30Days |
METOPROLOL TARTRATE 100 MG TABLET [Lopressor] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL TARTRATE 100 MG TABLET [Lopressor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOPROLOL TARTRATE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL TARTRATE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOPROLOL TARTRATE 37.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL TARTRATE 37.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOPROLOL TARTRATE 50 MG TABLET [Lopressor] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL TARTRATE 50 MG TABLET [Lopressor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOPROLOL TARTRATE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL TARTRATE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METOPROLOL-HCTZ 100-25 MG TABLET [Lopressor HCT] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL-HCTZ 100-25 MG TABLET [Lopressor HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOPROLOL-HCTZ 50-25 MG TABLET [Lopressor HCT] ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL-HCTZ 50-25 MG TABLET [Lopressor HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METRONIDAZOLE 250 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in PR cover METRONIDAZOLE 250 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METRONIDAZOLE 500 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in PR cover METRONIDAZOLE 500 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU] ![Compare how all Medicare Part D PDP plans in PR cover METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax] ![Compare how all Medicare Part D PDP plans in PR cover METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole] ![Compare how all Medicare Part D PDP plans in PR cover METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
METYROSINE 250 MG CAPSULE [Demser] ![Compare how all Medicare Part D PDP plans in PR cover METYROSINE 250 MG CAPSULE [Demser].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
MEXILETINE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MEXILETINE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MEXILETINE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MEXILETINE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MEXILETINE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MEXILETINE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MIDODRINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MIDODRINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MIDODRINE HCL 2.5 MG TABLET [ProAmatine] ![Compare how all Medicare Part D PDP plans in PR cover MIDODRINE HCL 2.5 MG TABLET [ProAmatine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIDODRINE HCL 5 MG TABLET [ProAmatine] ![Compare how all Medicare Part D PDP plans in PR cover MIDODRINE HCL 5 MG TABLET [ProAmatine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MIGLUSTAT 100 MG CAPSULE [Zavesca] ![Compare how all Medicare Part D PDP plans in PR cover MIGLUSTAT 100 MG CAPSULE [Zavesca].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | P |
MINITRAN 0.1 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in PR cover MINITRAN 0.1 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINITRAN 0.2 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in PR cover MINITRAN 0.2 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINITRAN 0.4 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in PR cover MINITRAN 0.4 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINITRAN 0.6 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in PR cover MINITRAN 0.6 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINOCYCLINE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MINOCYCLINE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MINOCYCLINE 50 MG CAPSULE [Minocin PAC] ![Compare how all Medicare Part D PDP plans in PR cover MINOCYCLINE 50 MG CAPSULE [Minocin PAC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MINOCYCLINE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PR cover MINOCYCLINE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINOXIDIL 10 MG TABLET [Loniten] ![Compare how all Medicare Part D PDP plans in PR cover MINOXIDIL 10 MG TABLET [Loniten].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MINOXIDIL 2.5 MG TABLET [Loniten] ![Compare how all Medicare Part D PDP plans in PR cover MINOXIDIL 2.5 MG TABLET [Loniten].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIRTAZAPINE 15 MG ODT ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 15 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 15 MG TABLET [Remeron] ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 15 MG TABLET [Remeron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | Q:30 /30Days |
MIRTAZAPINE 30 MG ODT ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 30 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 30 MG TABLET [Remeron] ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 30 MG TABLET [Remeron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | Q:30 /30Days |
MIRTAZAPINE 45 MG ODT ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 45 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 45 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | Q:30 /30Days |
MIRTAZAPINE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MIRTAZAPINE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
MISOPROSTOL 200 MCG TABLET [Cytotec] ![Compare how all Medicare Part D PDP plans in PR cover MISOPROSTOL 200 MCG TABLET [Cytotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MODAFINIL 100 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in PR cover MODAFINIL 100 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MODAFINIL 200 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in PR cover MODAFINIL 200 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MOEXIPRIL HCL 15 MG TABLET [Univasc] ![Compare how all Medicare Part D PDP plans in PR cover MOEXIPRIL HCL 15 MG TABLET [Univasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOEXIPRIL HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MOEXIPRIL HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$2.00 | $4.00 | None |
MOLINDONE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MOLINDONE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MOLINDONE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MOLINDONE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MOLINDONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MOLINDONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MOMETASONE FUROATE 0.1% CREAM (g) [Elocon] ![Compare how all Medicare Part D PDP plans in PR cover MOMETASONE FUROATE 0.1% CREAM (g) [Elocon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MOMETASONE FUROATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in PR cover MOMETASONE FUROATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MOMETASONE FUROATE 0.1% SOLUTION ![Compare how all Medicare Part D PDP plans in PR cover MOMETASONE FUROATE 0.1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MONTELUKAST SOD 10 MG TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in PR cover MONTELUKAST SOD 10 MG TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MONTELUKAST SOD 4 MG CHEWABLE TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in PR cover MONTELUKAST SOD 4 MG CHEWABLE TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MONTELUKAST SOD 4 MG GRANULES [Singulair] ![Compare how all Medicare Part D PDP plans in PR cover MONTELUKAST SOD 4 MG GRANULES [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | None |
MONTELUKAST SOD 5 MG CHEWABLE TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in PR cover MONTELUKAST SOD 5 MG CHEWABLE TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULF 100 MG/5 ML CONC SOLUTION [Roxanol-T] ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF 100 MG/5 ML CONC SOLUTION [Roxanol-T].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
MORPHINE SULF ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:36 /30Days |
MORPHINE SULF ER 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF ER 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:90 /30Days |
MORPHINE SULF ER 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF ER 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:60 /30Days |
MORPHINE SULF ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:90 /30Days |
MORPHINE SULF ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULF ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P Q:90 /30Days |
MORPHINE SULFATE IR 15 MG TABLET [MSIR] ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULFATE IR 15 MG TABLET [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:180 /30Days |
MORPHINE SULFATE IR 30 MG TABLET [MSIR] ![Compare how all Medicare Part D PDP plans in PR cover MORPHINE SULFATE IR 30 MG TABLET [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | Q:180 /30Days |
MOXIFLOXACIN 400 MG/250 ML BAG PIGGYBACK [Avelox I.V.] ![Compare how all Medicare Part D PDP plans in PR cover MOXIFLOXACIN 400 MG/250 ML BAG PIGGYBACK [Avelox I.V.].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PR cover Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
MUPIROCIN 2% OINTMENT [Centany AT] ![Compare how all Medicare Part D PDP plans in PR cover MUPIROCIN 2% OINTMENT [Centany AT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MYCAMINE 100 MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover MYCAMINE 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
MYCAMINE 50 MG VIAL ![Compare how all Medicare Part D PDP plans in PR cover MYCAMINE 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
MYCOPHENOLATE 200 MG/ML SUSP ![Compare how all Medicare Part D PDP plans in PR cover MYCOPHENOLATE 200 MG/ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MYCOPHENOLATE 250 MG CAPSULE [CellCept] ![Compare how all Medicare Part D PDP plans in PR cover MYCOPHENOLATE 250 MG CAPSULE [CellCept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$14.00 | $28.00 | P |
MYCOPHENOLATE 500 MG TABLET [CellCept] ![Compare how all Medicare Part D PDP plans in PR cover MYCOPHENOLATE 500 MG TABLET [CellCept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MYCOPHENOLIC ACID DR 180 MG TABLET DR [Myfortic] ![Compare how all Medicare Part D PDP plans in PR cover MYCOPHENOLIC ACID DR 180 MG TABLET DR [Myfortic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MYCOPHENOLIC ACID DR 360 MG TABLET DR [Myfortic] ![Compare how all Medicare Part D PDP plans in PR cover MYCOPHENOLIC ACID DR 360 MG TABLET DR [Myfortic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $30.00 | P |
MYRBETRIQ ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MYRBETRIQ ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
MYRBETRIQ ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PR cover MYRBETRIQ ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |