Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


2021 Medicare Part D and Medicare Advantage Plan Formulary Browser

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 002 (HMO D-SNP) (H0982-002-0)
Tier 1 (702)
Tier 2 (1750)
Tier 3 (467)
Tier 4 (435)
Tier 5 (566)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2021 Medicare Part D Plan Formulary Information
SOLIS SPF 002 (HMO D-SNP) (H0982-002-0)
Benefits & Contact Info           
The SOLIS SPF 002 (HMO D-SNP) (H0982-002-0)
Formulary Drugs Starting with the Letter M

in Miami-Dade County, FL: CMS MA Region 9 which includes: FL
Plan Monthly Premium: $30.80 Deductible: $0
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   3 Preferred Brand 0%N/ANone
MAGNESIUM SULFATE 50% VIAL   2 Generic 0%0%None
MAGNESIUM SULFATE INJECTION 5 GM/10ML   2 Generic 0%0%None
MALATHION 0.5% LOTION   2 Generic 0%0%None
MAPROTILINE 25MG TABLET   2 Generic 0%0%None
MAPROTILINE 50MG TABLET   2 Generic 0%0%None
MAPROTILINE 75MG TABLET   2 Generic 0%0%None
MARLISSA-28 TABLET   2 Generic 0%0%None
MARPLAN 10MG TABLET (100 CT)   3 Preferred Brand 0%N/ANone
MATULANE 50 MG CAPSULE   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MATZIM LA 180 MG TABLET   2 Generic 0%0%None
MATZIM LA 240 MG TABLET   2 Generic 0%0%None
MATZIM LA 300 MG TABLET   2 Generic 0%0%None
MATZIM LA 360 MG TABLET   2 Generic 0%0%None
MATZIM LA 420 MG TABLET   2 Generic 0%0%None
MAVYRET 100-40 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
MAXIDEX OPHTHALMIC SUSPENSION 0.1% 5ML BOTTLE   3 Preferred Brand 0%N/ANone
MAYZENT 0.25 MG TABLET   5 Specialty Tier 25%N/ANone
MAYZENT 2 MG TABLET   5 Specialty Tier 25%N/ANone
MECLIZINE 12.5 MG TABLET [Antivert]   1 Preferred Generic 0%0%None
MECLIZINE 25 MG TABLET   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MEDROL 2 MG TABLET   3 Preferred Brand 0%N/AP
MEDROXYPROGESTERONE 10 MG TABLET [Provera]   1 Preferred Generic 0%0%None
MEDROXYPROGESTERONE 150 MG/ML SYRINGE [Depo-Provera]   2 Generic 0%0%None
MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera]   2 Generic 0%0%None
MEDROXYPROGESTERONE 2.5 MG TABLET [Provera]   1 Preferred Generic 0%0%None
MEDROXYPROGESTERONE 5 MG TABLET [Provera]   1 Preferred Generic 0%0%None
MEFLOQUINE HCL 250 MG TABLET   3 Preferred Brand 0%N/ANone
MEGESTROL 20 MG TABLET   2 Generic 0%0%P
MEGESTROL 40 MG TABLET   2 Generic 0%0%P
MEGESTROL 625 MG/5 ML ORAL SUSPENSION [Megace ES]   2 Generic 0%0%P
MEGESTROL ACET 40 MG/ML ORAL SUSPENSION [Megace]   2 Generic 0%0%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MEKINIST 0.5 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
MEKINIST 2 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
MEKTOVI 15 MG TABLET   5 Specialty Tier 25%N/AP Q:180
/30Days
MELODETTA 24 FE CHEWABLE TABLET [Minastrin]   2 Generic 0%0%None
MELOXICAM 15 MG TABLET   1 Preferred Generic 0%0%None
MELOXICAM 7.5 MG TABLET   1 Preferred Generic 0%0%None
MEMANTINE 5-10 MG TITRATION PK [Namenda Titration]   1 Preferred Generic 0%0%None
MEMANTINE HCL 10 MG TABLET [Namenda]   1 Preferred Generic 0%0%None
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda]   2 Generic 0%0%None
MEMANTINE HCL 5 MG TABLET [Namenda]   1 Preferred Generic 0%0%None
MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda XR]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda XR]   2 Generic 0%0%None
MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda XR]   2 Generic 0%0%None
MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda XR]   2 Generic 0%0%None
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   3 Preferred Brand 0%N/ANone
MENEST 0.3MG TABLET   4 Non-Preferred Brand 25%N/ANone
MENEST 0.625MG TABLET   4 Non-Preferred Brand 25%N/ANone
MENEST 1.25MG TABLET   4 Non-Preferred Brand 25%N/ANone
MENOSTAR 14 MCG/DAY PATCH   4 Non-Preferred Brand 25%N/ANone
MENTAX 1% CREAM   4 Non-Preferred Brand 25%N/AQ:120
/30Days
MENVEO A-C-Y-W-135-DIP VIAL   3 Preferred Brand 0%N/ANone
MERCAPTOPURINE 50 MG TABLET   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MEROPENEM IV 1 GM VIAL [Merrem]   2 Generic 0%0%None
MEROPENEM IV 500 MG VIAL [Merrem]   2 Generic 0%0%None
MESALAMINE 1,000 MG SUPP.RECT [Canasa]   2 Generic 0%0%None
MESALAMINE 4 GM/60 ML ENEMA   2 Generic 0%0%None
MESALAMINE 800 MG DR TABLET DR [Asacol HD]   2 Generic 0%0%None
MESALAMINE DR 1.2 GM TABLET   2 Generic 0%0%None
MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol]   2 Generic 0%0%None
MESALAMINE ER 0.375 GRAM CAPSULE 24H [Apriso]   2 Generic 0%0%None
MESNEX 400MG TABLET   3 Preferred Brand 0%N/ANone
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC   3 Preferred Brand 0%N/ANone
METAXALONE 400 MG TABLET [Skelaxin]   4 Non-Preferred Brand 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METAXALONE 800 MG TABLET [Skelaxin]   2 Generic 0%0%None
METFORMIN HCL 1,000 MG TABLET   1 Preferred Generic 0%0%None
METFORMIN HCL 500 MG TABLET   1 Preferred Generic 0%0%None
METFORMIN HCL 500 MG/5 ML SOLUTION [Riomet]   2 Generic 0%0%None
METFORMIN HCL 850 MG TABLET [Glucophage]   1 Preferred Generic 0%0%None
METFORMIN HCL ER 500 MG TABLET ER 24H [Prozac]   1 Preferred Generic 0%0%None
METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR]   1 Preferred Generic 0%0%None
METHADONE 10 MG/5 ML SOLUTION   2 Generic 0%0%Q:1800
/30Days
METHADONE 5 MG/5 ML SOLUTION   2 Generic 0%0%Q:3600
/30Days
METHADONE HCL 10 MG TABLET [Methadose]   2 Generic 0%0%Q:360
/30Days
METHADONE HCL 5 MG TABLET [Methadose]   2 Generic 0%0%Q:360
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHAZOLAMIDE 25 MG TABLET [Neptazane]   2 Generic 0%0%None
METHAZOLAMIDE 50 MG TABLET [Neptazane]   2 Generic 0%0%None
METHENAMINE HIPP 1 GM TABLET [Urex]   2 Generic 0%0%None
METHIMAZOLE 10 MG TABLET [Tapazole]   1 Preferred Generic 0%0%None
METHIMAZOLE 5 MG TABLET [Tapazole]   1 Preferred Generic 0%0%None
METHITEST 10MG TABLET   4 Non-Preferred Brand 25%N/AP
METHOCARBAMOL 500 MG TABLET [Robaxin]   1 Preferred Generic 0%0%None
METHOCARBAMOL 750 MG TABLET [Robaxin]   1 Preferred Generic 0%0%None
METHOTREXATE 2.5 MG TABLET [Rheumatrex]   1 Preferred Generic 0%0%None
METHOTREXATE 50 MG/2 ML VIAL   1 Preferred Generic 0%0%None
METHOTREXATE 50 MG/2 ML VIAL   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Methoxsalen 10 mg Capsule [8-MOP]   2 Generic 0%0%None
METHSCOPOLAMINE BROM 2.5 MG TABLET [Pamine]   2 Generic 0%0%None
METHSCOPOLAMINE BROM 5 MG TABLET [Pamine Forte]   2 Generic 0%0%None
METHYLDOPA 250 MG TABLET   2 Generic 0%0%None
METHYLDOPA 500 MG TABLET   2 Generic 0%0%None
METHYLDOPA-HCTZ 250-25 MG TABLET [Aldoril]   2 Generic 0%0%None
METHYLDOPA/HCTZ 250-15 TABLET   2 Generic 0%0%None
METHYLPHENIDATE 10 MG CHEW TABLET [Methylin]   2 Generic 0%0%None
METHYLPHENIDATE 10 MG TABLET [Ritalin]   2 Generic 0%0%None
METHYLPHENIDATE 10 MG/5 ML SOLUTION [Methylin]   2 Generic 0%0%None
METHYLPHENIDATE 2.5 MG CHEW TABLET [Methylin]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHYLPHENIDATE 20 MG TABLET [Ritalin]   2 Generic 0%0%None
METHYLPHENIDATE 5 MG CHEW TABLET [Methylin]   2 Generic 0%0%None
METHYLPHENIDATE 5 MG TABLET [Ritalin]   2 Generic 0%0%None
METHYLPHENIDATE 5 MG/5 ML SOLUTION [Methylin]   2 Generic 0%0%None
METHYLPHENIDATE CD 20 MG CAPSULE CPBP 30-70 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE CD 30 MG CAPSULE CPBP 30-70 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE CD 40 MG CAPSULE CPBP 30-70 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE CD 50 MG CAPSULE CPBP 30-70 [Metadate CD]   2 Generic 0%0%None
METHYLPHENIDATE ER 10 MG TABLET [Methylin]   2 Generic 0%0%None
METHYLPHENIDATE ER 18 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER 18 MG TABLET ER 24 [Concerta]   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR]   2 Generic 0%0%None
METHYLPHENIDATE ER 27 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER 27 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER 36 MG TABLET   2 Generic 0%0%None
METHYLPHENIDATE ER 36 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER 54 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER 54 MG TABLET ER 24 [Concerta]   2 Generic 0%0%None
METHYLPHENIDATE ER(CD) 10MG CAPSULE CPBP 30-70 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE ER(CD) 60MG CAPSULE CPBP 30-70 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE ER(LA) 10MG CAPSULE CPBP 50-50 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE ER(LA) 30MG CAPSULE CPBP 50-50 [Ritalin LA]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METHYLPHENIDATE ER(LA) 40MG CAPSULE CPBP 50-50 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE LA 20 MG CAPSULE CPBP 50-50 [Ritalin LA]   2 Generic 0%0%None
METHYLPHENIDATE LA 60 MG CAPSULE CPBP 50-50 [Ritalin LA]   2 Generic 0%0%None
METHYLPREDNISOLONE 16 MG TABLET [Medrol Dosepak]   2 Generic 0%0%P
METHYLPREDNISOLONE 32 MG TABLET [Medrol]   2 Generic 0%0%P
METHYLPREDNISOLONE 4 MG DOSEPK   2 Generic 0%0%None
METHYLPREDNISOLONE 4 MG TABLET   2 Generic 0%0%P
METHYLPREDNISOLONE 8 MG TABLET [Medrol]   2 Generic 0%0%P
METHYLTESTOSTERONE 10 MG CAPSULE   4 Non-Preferred Brand 25%N/AP
Metoclopramide 10mg/1 500 TABLET BOTTLE   1 Preferred Generic 0%0%None
METOCLOPRAMIDE 5 MG TABLET   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METOCLOPRAMIDE 5 MG/5 ML SOLUTION   2 Generic 0%0%None
METOLAZONE 10 MG TABLET [Zaroxolyn]   2 Generic 0%0%None
METOLAZONE 2.5 MG TABLET [Zaroxolyn]   2 Generic 0%0%None
METOLAZONE 5 MG TABLET [Zaroxolyn]   2 Generic 0%0%None
METOPROLOL SUCC ER 100 MG TABLET ER 24H [Toprol XL]   1 Preferred Generic 0%0%None
METOPROLOL SUCC ER 200 MG TABLET ER 24H [Toprol XL]   1 Preferred Generic 0%0%None
METOPROLOL SUCC ER 25 MG TABLET ER 24H [Toprol XL]   1 Preferred Generic 0%0%None
METOPROLOL SUCC ER 50 MG TAB   1 Preferred Generic 0%0%None
METOPROLOL TARTRATE 100 MG TABLET [Lopressor]   1 Preferred Generic 0%0%None
METOPROLOL TARTRATE 25 MG TABLET   1 Preferred Generic 0%0%None
METOPROLOL TARTRATE 50 MG TABLET [Lopressor]   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METOPROLOL-HCTZ 100-25 MG TABLET [Lopressor HCT]   2 Generic 0%0%None
METOPROLOL-HCTZ 50-25 MG TABLET [Lopressor HCT]   2 Generic 0%0%None
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET   2 Generic 0%0%None
METRONIDAZOLE 0.75% CREAM (g) [Vitazol]   2 Generic 0%0%None
METRONIDAZOLE 0.75% LOTION [MetroLotion]   2 Generic 0%0%None
METRONIDAZOLE 250 MG TABLET [Flagyl]   1 Preferred Generic 0%0%None
METRONIDAZOLE 375 MG CAPSULE [Flagyl]   2 Generic 0%0%None
METRONIDAZOLE 500 MG TABLET [Flagyl]   1 Preferred Generic 0%0%None
METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU]   2 Generic 0%0%None
METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax]   2 Generic 0%0%None
METRONIDAZOLE TOPICAL 1% GEL [MetroGel]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole]   2 Generic 0%0%None
MEXILETINE 150MG CAPSULE   4 Non-Preferred Brand 25%N/ANone
MEXILETINE 200MG CAPSULE   4 Non-Preferred Brand 25%N/ANone
MEXILETINE 250MG CAPSULE   4 Non-Preferred Brand 25%N/ANone
MIBELAS 24 FE CHEWABLE TABLET [Minastrin]   2 Generic 0%0%None
MICAFUNGIN 100 MG VIAL [Mycamine]   2 Generic 0%0%None
MICAFUNGIN 50 MG VIAL [Mycamine]   2 Generic 0%0%None
MICONAZOLE 3 200MG SUPPOS.   4 Non-Preferred Brand 25%N/ANone
MICROGESTIN 21 1-20 TABLET   2 Generic 0%0%None
MICROGESTIN 21 1.5-30 TABLET   2 Generic 0%0%None
MICROGESTIN FE 1-20 TABLET [Tarina Fe 1/20]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MICROGESTIN FE 1.5-30 TABLET   2 Generic 0%0%None
MIDODRINE HCL 10 MG TABLET   2 Generic 0%0%None
MIDODRINE HCL 2.5 MG TABLET [ProAmatine]   2 Generic 0%0%None
MIDODRINE HCL 5 MG TABLET [ProAmatine]   2 Generic 0%0%None
MIGLITOL 100 MG TABLET [Glyset]   2 Generic 0%0%None
MIGLITOL 25 MG TABLET [Glyset]   2 Generic 0%0%None
MIGLITOL 50 MG TABLET [Glyset]   2 Generic 0%0%None
MIGLUSTAT 100 MG CAPSULE [Zavesca]   5 Specialty Tier 25%N/AP
MILI 0.25-0.035 MG TABLET [VyLibra]   2 Generic 0%0%None
MILLIPRED 5 MG TABLET   4 Non-Preferred Brand 25%N/AP
MIMVEY 1-0.5 MG TABLET   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MINITRAN 0.1 MG/HR PATCH   1 Preferred Generic 0%0%None
MINITRAN 0.2 MG/HR PATCH   1 Preferred Generic 0%0%None
MINITRAN 0.4 MG/HR PATCH   1 Preferred Generic 0%0%None
MINITRAN 0.6 MG/HR PATCH   1 Preferred Generic 0%0%None
MINOCYCLINE 100 MG CAPSULE   1 Preferred Generic 0%0%None
MINOCYCLINE 50 MG CAPSULE [Minocin PAC]   1 Preferred Generic 0%0%None
MINOCYCLINE 75 MG CAPSULE   1 Preferred Generic 0%0%None
MINOCYCLINE HCL 100 MG TABLET   2 Generic 0%0%None
MINOCYCLINE HCL 75 MG TABLET   2 Generic 0%0%None
MINOCYCLINE HYDROCHLORIDE 50 MG TABLET   2 Generic 0%0%None
MINOXIDIL 10 MG TABLET [Loniten]   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MINOXIDIL 2.5 MG TABLET [Loniten]   1 Preferred Generic 0%0%None
MIRTAZAPINE 15 MG ODT   2 Generic 0%0%None
MIRTAZAPINE 15 MG TABLET [Remeron]   1 Preferred Generic 0%0%None
MIRTAZAPINE 30 MG ODT   2 Generic 0%0%None
MIRTAZAPINE 30 MG TABLET [Remeron]   1 Preferred Generic 0%0%None
MIRTAZAPINE 45 MG ODT   2 Generic 0%0%None
MIRTAZAPINE 45 MG TABLET   1 Preferred Generic 0%0%None
MIRTAZAPINE 7.5 MG TABLET   2 Generic 0%0%None
MISOPROSTOL 100 MCG TABLET [Cytotec]   2 Generic 0%0%None
MISOPROSTOL 200 MCG TABLET [Cytotec]   2 Generic 0%0%None
MITIGARE 0.6 MG CAPSULE   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MODAFINIL 100 MG TABLET [Provigil]   2 Generic 0%0%P Q:60
/30Days
MODAFINIL 200 MG TABLET [Provigil]   2 Generic 0%0%P Q:60
/30Days
MOEXIPRIL HCL 15 MG TABLET [Univasc]   2 Generic 0%0%None
MOEXIPRIL HCL 7.5 MG TABLET   2 Generic 0%0%None
MOLINDONE HCL 10 MG TABLET   4 Non-Preferred Brand 25%N/ANone
MOLINDONE HCL 25 MG TABLET   4 Non-Preferred Brand 25%N/ANone
MOLINDONE HCL 5 MG TABLET   4 Non-Preferred Brand 25%N/ANone
MOMETASONE FUROATE 0.1% CREAM (g) [Elocon]   2 Generic 0%0%None
MOMETASONE FUROATE 0.1% OINTMENT   2 Generic 0%0%None
MOMETASONE FUROATE 0.1% SOLUTION   2 Generic 0%0%None
MONDOXYNE NL 100 MG CAPSULE [Monodox]   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MONTELUKAST SOD 10 MG TABLET [Singulair]   1 Preferred Generic 0%0%None
MONTELUKAST SOD 4 MG CHEWABLE TABLET [Singulair]   1 Preferred Generic 0%0%None
MONTELUKAST SOD 4 MG GRANULES [Singulair]   2 Generic 0%0%None
MONTELUKAST SOD 5 MG CHEWABLE TABLET [Singulair]   1 Preferred Generic 0%0%None
MONUROL 3 GM SACHET   4 Non-Preferred Brand 25%N/ANone
MORPHINE SULF 10 MG/5 ML SOLUTION [MSIR]   2 Generic 0%0%Q:1800
/30Days
MORPHINE SULF 100 MG/5 ML CONC SOLUTION [Roxanol-T]   2 Generic 0%0%Q:180
/30Days
MORPHINE SULF 20 MG/5 ML SOLUTION [MSIR]   2 Generic 0%0%Q:900
/30Days
MORPHINE SULF ER 100 MG TABLET   2 Generic 0%0%Q:120
/30Days
MORPHINE SULF ER 15 MG TABLET   2 Generic 0%0%Q:120
/30Days
MORPHINE SULF ER 200 MG TABLET   2 Generic 0%0%Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MORPHINE SULF ER 30 MG TABLET   2 Generic 0%0%Q:120
/30Days
MORPHINE SULF ER 60 MG TABLET   2 Generic 0%0%Q:120
/30Days
MORPHINE SULFATE IR 15 MG TABLET [MSIR]   2 Generic 0%0%Q:180
/30Days
MORPHINE SULFATE IR 30 MG TABLET [MSIR]   2 Generic 0%0%Q:180
/30Days
MOTEGRITY 1 MG TABLET   4 Non-Preferred Brand 25%N/AP
MOTEGRITY 2 MG TABLET   4 Non-Preferred Brand 25%N/AP
MOVANTIK 12.5 MG TABLET   3 Preferred Brand 0%N/AP
MOVANTIK 25 MG TABLET   3 Preferred Brand 0%N/AP
MOXIFLOXACIN 0.5% EYE DROPS [Vigamox]   1 Preferred Generic 0%0%Q:6
/7Days
MOXIFLOXACIN 400 MG/250 ML BAG PIGGYBACK [Avelox I.V.]   2 Generic 0%0%None
MOXIFLOXACIN HCL 400 MG TABLET [Avelox ABC Pack]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE   3 Preferred Brand 0%N/ANone
MUPIROCIN 2% OINTMENT [Centany AT]   2 Generic 0%0%Q:220
/30Days
MYCOPHENOLATE 200 MG/ML SUSP   2 Generic 0%0%P
MYCOPHENOLATE 250 MG CAPSULE [CellCept]   2 Generic 0%0%P
MYCOPHENOLATE 500 MG TABLET [CellCept]   2 Generic 0%0%P
MYCOPHENOLIC ACID DR 180 MG TABLET DR [Myfortic]   2 Generic 0%0%P
MYCOPHENOLIC ACID DR 360 MG TABLET DR [Myfortic]   2 Generic 0%0%P
MYORISAN 10 MG CAPSULE   2 Generic 0%0%None
MYORISAN 20 MG CAPSULE   2 Generic 0%0%None
Myorisan 30 mg capsule   2 Generic 0%0%None
MYORISAN 40 MG CAPSULE   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
MYRBETRIQ ER 25 MG TABLET   3 Preferred Brand 0%N/ANone
MYRBETRIQ ER 50 MG TABLET   3 Preferred Brand 0%N/ANone

Chart Legend:

Below are a few notes to help you understand the above 2021 Medicare Part D SOLIS SPF 002 (HMO D-SNP) 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 $445 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 $4130) 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.

      * When the text "$35 or less" appears, this Part D plan may offer this particular insulin as part of the Senior Savings Model.  The Senior Savings Model stipulates that the insulin will cost no more than $35 in the deductible, initial coverage, and coverage gap phases of your Part D plan. Please contact the drug plan for more details.

    • 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 January 2021 )

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








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