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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
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Cick on the first letter of your drug name to browse the formulary:

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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 N

in Miami-Dade County, FL: CMS MA Region 9 which includes: FL
Plan Monthly Premium: $30.80 Deductible: $0
Drugs Starting with Letter N

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
NABUMETONE 500 MG TABLET [Relafen]   2 Generic 0%0%None
NABUMETONE 750 MG TABLET   2 Generic 0%0%None
NADOLOL 20 MG TABLET   2 Generic 0%0%None
NADOLOL 40 MG TABLET [Corgard]   2 Generic 0%0%None
NADOLOL 80 MG TABLET   2 Generic 0%0%None
NAFCILLIN 1 GM VIAL   2 Generic 0%0%None
NAFCILLIN 10 GM BULK VIAL   2 Generic 0%0%None
NAFCILLIN 2 GM VIAL   2 Generic 0%0%None
NAFTIFINE HCL 1% CREAM (g) [Naftin-MP]   2 Generic 0%0%Q:270
/30Days
NAFTIFINE HCL 2% CREAM (g) [Naftin]   2 Generic 0%0%Q:240
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAFTIN 2% GEL   4 Non-Preferred Brand 25%N/AQ:270
/30Days
NALOXONE 0.4 MG/ML CARPUJECT CARTRIDGE [Narcan]   2 Generic 0%0%Q:2
/2Days
NALOXONE 0.4 MG/ML VIAL [Narcan]   2 Generic 0%0%Q:2
/2Days
naloxone 1 mg/ml syringe   1 Preferred Generic 0%0%None
NALTREXONE 50 MG TABLET [ReVia]   1 Preferred Generic 0%0%None
NAMENDA XR TITRATION PACK   4 Non-Preferred Brand 25%N/ANone
NAPROXEN 250 MG TABLET [Naprosyn]   1 Preferred Generic 0%0%None
NAPROXEN 375 MG TABLET   1 Preferred Generic 0%0%None
NAPROXEN 500 MG TABLET   1 Preferred Generic 0%0%None
NAPROXEN DR 375 MG TABLET   1 Preferred Generic 0%0%None
NAPROXEN DR 500 MG TABLET DR [EC-Naprosyn]   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAPROXEN SODIUM 275 MG TABLET [Anaprox]   2 Generic 0%0%None
NAPROXEN SODIUM 550 MG TABLET [Anaprox DS]   2 Generic 0%0%None
NARATRIPTAN HCL 1 MG TABLET   2 Generic 0%0%Q:18
/30Days
NARATRIPTAN HCL 2.5 MG TABLET   2 Generic 0%0%Q:18
/30Days
NARCAN 4 MG NASAL SPRAY   3 Preferred Brand 0%N/ANone
NATACYN EYE DROPS   3 Preferred Brand 0%N/AQ:15
/7Days
Natazia 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK   4 Non-Preferred Brand 25%N/ANone
NATEGLINIDE 120 MG TABLET [Starlix]   2 Generic 0%0%None
NATEGLINIDE 60 MG TABLET [Starlix]   2 Generic 0%0%None
NATPARA 100 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP
NATPARA 25 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NATPARA 50 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP
NATPARA 75 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP
NAYZILAM 5 MG NASAL SPRAY   4 Non-Preferred Brand 25%N/ANone
NECON 0.5-35-28 TABLET   2 Generic 0%0%None
NEFAZODONE HCL 150MG TABLET (60 CT)   4 Non-Preferred Brand 25%N/ANone
NEFAZODONE HCL 250MG TABLET   2 Generic 0%0%None
NEFAZODONE HCL 50MG TABLET   2 Generic 0%0%None
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT   4 Non-Preferred Brand 25%N/ANone
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT   4 Non-Preferred Brand 25%N/ANone
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT   2 Generic 0%0%None
NEOMYC-POLYM-DEXAMET EYE OINTMENT [Poly-Dex]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEOMYC-POLYM-DEXAMETH EYE DROP   2 Generic 0%0%None
NEOMYCIN SULFATE 500MG TABLET   1 Preferred Generic 0%0%None
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT   2 Generic 0%0%None
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS   2 Generic 0%0%None
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M   2 Generic 0%0%Q:10
/7Days
NEOMYCIN/POLYMY/HYDRO OTIC SUS   2 Generic 0%0%None
NEPHRAMINE SOLUTION FOR INJECTION   4 Non-Preferred Brand 25%N/AP
NERLYNX 40 MG TABLET   5 Specialty Tier 25%N/AP
Neuac gel   2 Generic 0%0%Q:90
/30Days
NEUPRO 1 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
NEUPRO 2 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEUPRO 3 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
NEUPRO 4 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
NEUPRO 6 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
NEUPRO 8 MG/24 HR PATCH   4 Non-Preferred Brand 25%N/ANone
NEVANAC 0.1% DROPTAINER   3 Preferred Brand 0%N/ANone
NEVIRAPINE 200 MG TABLET   1 Preferred Generic 0%0%None
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [Viramune]   2 Generic 0%0%None
NEVIRAPINE ER 100 MG TABLET ER 24H [Viramune XR]   3 Preferred Brand 0%N/ANone
NEVIRAPINE ER 400 MG TABLET ER 24H [Viramune XR]   2 Generic 0%0%None
NEXAVAR TABLETS 200MG 120 BOT   5 Specialty Tier 25%N/AP
NIACIN ER 1,000 MG TABLET [Niaspan ER]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIACIN ER 500 MG TABLET [Niaspan ER]   2 Generic 0%0%None
NIACIN ER 750 MG TABLET [Niaspan ER]   2 Generic 0%0%None
Nicardipine hydrochloride 20 MG Oral Capsule   2 Generic 0%0%None
Nicardipine hydrochloride 30 MG Oral Capsule   2 Generic 0%0%None
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL   3 Preferred Brand 0%N/ANone
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL   3 Preferred Brand 0%N/ANone
NIFEDIPINE 10 MG CAPSULE [Procardia]   2 Generic 0%0%None
NIFEDIPINE 20MG CAPSULE   2 Generic 0%0%None
NIFEDIPINE ER 30 MG TABLET ER [Nifediac CC]   2 Generic 0%0%None
NIFEDIPINE ER 30 MG TABLET ER [Procardia XL]   2 Generic 0%0%None
NIFEDIPINE ER 60 MG TABLET ER [Nifediac CC]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIFEDIPINE ER 60 MG TABLET ER [Procardia XL]   2 Generic 0%0%None
NIFEDIPINE ER 90 MG TABLET ER [Nifediac CC]   2 Generic 0%0%None
NIFEDIPINE ER 90 MG TABLET ER [Procardia XL]   2 Generic 0%0%None
NIKKI 3 MG-0.02 MG TABLET [Yaz]   2 Generic 0%0%None
NILUTAMIDE 150 MG TABLET [Nilandron]   5 Specialty Tier 25%N/ANone
NIMODIPINE 30 MG CAPSULE [Nimotop]   2 Generic 0%0%None
NINLARO 2.3 MG CAPSULE   5 Specialty Tier 25%N/AP
NINLARO 3 MG CAPSULE   5 Specialty Tier 25%N/AP
NINLARO 4 MG CAPSULE   5 Specialty Tier 25%N/AP
NISOLDIPINE ER 17 MG TABLET ER 24H [Sular]   2 Generic 0%0%None
NISOLDIPINE ER 20 MG TABLET 24H [Sular]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NISOLDIPINE ER 25.5 MG TABLET 24H [Sular]   2 Generic 0%0%None
NISOLDIPINE ER 30 MG TABLET 24H [Sular]   2 Generic 0%0%None
NISOLDIPINE ER 34 MG TABLET ER 24H [Sular]   2 Generic 0%0%None
NISOLDIPINE ER 40 MG TABLET 24H [Sular]   2 Generic 0%0%None
NISOLDIPINE ER 8.5 MG TABLET ER 24H [Sular]   2 Generic 0%0%None
NITISINONE 10 MG CAPSULE [Orfadin]   5 Specialty Tier 25%N/AP
NITISINONE 2 MG CAPSULE [Orfadin]   5 Specialty Tier 25%N/AP
NITISINONE 5 MG CAPSULE [Orfadin]   5 Specialty Tier 25%N/AP
NITRO-BID 2% OINTMENT   3 Preferred Brand 0%N/ANone
NITRO-DUR 0.3 MG/HR PATCH   4 Non-Preferred Brand 25%N/ANone
NITRO-DUR 0.8 MG/HR PATCH   4 Non-Preferred Brand 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NITROFURANTOIN MCR 100 MG CAPSULE [Macrodantin]   2 Generic 0%0%None
NITROFURANTOIN MCR 50 MG CAPSULE [Macrodantin]   2 Generic 0%0%None
NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid]   2 Generic 0%0%None
NITROGLYCERIN 0.2 MG/HR PATCH [Nitrodisc]   1 Preferred Generic 0%0%None
NITROGLYCERIN 0.3 MG TABLET SL   1 Preferred Generic 0%0%None
NITROGLYCERIN 0.4 MG SUBLIGUAL TABLET [Nitrotab]   1 Preferred Generic 0%0%None
NITROGLYCERIN 0.4 MG/HR PATCH [Transdermal-NTG]   1 Preferred Generic 0%0%None
NITROGLYCERIN 0.6 MG SUBLIGUAL TABLET [Nitrotab]   1 Preferred Generic 0%0%None
NITROGLYCERIN 0.6 MG/HR PATCH [Transdermal-NTG]   1 Preferred Generic 0%0%None
NITROGLYCERIN LINGUAL 0.4 MG   2 Generic 0%0%None
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIVESTYM 300 MCG/0.5 ML SYRINGE   5 Specialty Tier 25%N/ANone
NIVESTYM 300 MCG/ML VIAL   5 Specialty Tier 25%N/ANone
NIVESTYM 480 MCG/0.8 ML SYRINGE   5 Specialty Tier 25%N/ANone
NIVESTYM 480 MCG/1.6 ML VIAL   5 Specialty Tier 25%N/ANone
NIZATIDINE 150 MG CAPSULE [Axid]   2 Generic 0%0%None
NIZATIDINE 300 MG CAPSULE [Axid]   2 Generic 0%0%None
NORA-BE 0.35MG TABLET   2 Generic 0%0%None
noret-estr-fe 0.4-0.035(21)-75   2 Generic 0%0%None
NORETH-ESTRAD-FE 1-0.02(24)-75 Chewable TABLET [Minastrin]   2 Generic 0%0%None
Norethin-Estrad-Ferr 0.8-0.025 MG   2 Generic 0%0%None
NORETHIN-ETH ESTRAD 1 MG-5 MCG   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORETHIND-ETH ESTRAD 0.5-2.5 TABLET [Jevantique]   2 Generic 0%0%None
NORETHIND-ETH ESTRAD 1-0.02 MG   2 Generic 0%0%None
NORETHINDRONE 0.35 MG TABLET [Sharobel 28-Day]   2 Generic 0%0%None
NORETHINDRONE 5MG TABLET   2 Generic 0%0%None
NORG-EE 0.18-0.215-0.25/0.035   2 Generic 0%0%None
NORG-ETHIN ESTRA 0.18-0.215-0.25/0.025   2 Generic 0%0%None
NORG-ETHIN ESTRA 0.25-0.035 MG TABLET [VyLibra]   2 Generic 0%0%None
NORMOSOL-M AND DEXTROSE 5%   2 Generic 0%0%None
NORTHERA 100 MG CAPSULE   5 Specialty Tier 25%N/AP
NORTHERA 200 MG CAPSULE   5 Specialty Tier 25%N/AP
NORTHERA 300 MG CAPSULE   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK per CARTON / 21 TABLET per BLISTER PACK   2 Generic 0%0%None
Nortrel (28 Day Regimen) 3 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK   2 Generic 0%0%None
NORTREL 1-0.035MG TABLET 28DAY   2 Generic 0%0%None
Nortrel 7/7/7 (28 Day Regimen) 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER   2 Generic 0%0%None
NORTRIPTYLINE 10 MG/5 ML SOL   3 Preferred Brand 0%N/ANone
NORTRIPTYLINE HCL 25MG CAP   1 Preferred Generic 0%0%None
NORTRIPTYLINE HCL 50 MG CAP   1 Preferred Generic 0%0%None
NORTRIPTYLINE HCL 75 MG CAP   1 Preferred Generic 0%0%None
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE BOTTLE   1 Preferred Generic 0%0%None
NORVIR 100 MG POWDER PACKET   3 Preferred Brand 0%N/ANone
NORVIR 80MG/ML ORAL SOLUTION   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NOURIANZ 20 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:30
/30Days
NOURIANZ 40 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:30
/30Days
Novolin 100[iU]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL   3 Preferred Brand 0%N/ANone
Novolin 100[USP'U]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL   3 Preferred Brand 0%N/ANone
NOVOLIN N 100 UNIT/ML FLEXPEN INSULN PEN   3 Preferred Brand 0%N/ANone
NOVOLIN R 100 UNIT/ML FLEXPEN INSULN PEN   3 Preferred Brand 0%N/ANone
Novolin R 100[iU]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL   3 Preferred Brand 0%N/ANone
NOVOLOG 100 UNIT/ML CARTRIDGE   3 Preferred Brand 0%N/ANone
NOVOLOG 100U/ML VIAL   3 Preferred Brand 0%N/AP
NOVOLOG FLEXPEN SYRINGE   3 Preferred Brand 0%N/ANone
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NOVOLOG MIX 70/30 VIAL   3 Preferred Brand 0%N/ANone
NOXAFIL 200MG/5ML SUSPENSION ORAL   3 Preferred Brand 0%N/AP
NUBEQA 300 MG TABLET   5 Specialty Tier 25%N/AP Q:120
/30Days
NUCALA 100 MG VIAL   5 Specialty Tier 25%N/AP
NUCALA 100 MG/ML AUTO-INJECTOR AUTO INJCT   5 Specialty Tier 25%N/AP
NUCALA 100 MG/ML SYRINGE   5 Specialty Tier 25%N/AP
NUCYNTA ER 100 MG TABLET ER 12H   3 Preferred Brand 0%N/AQ:60
/30Days
NUCYNTA ER 150 MG TABLET ER 12H   3 Preferred Brand 0%N/AQ:60
/30Days
NUCYNTA ER 200 MG TABLET ER 12H   3 Preferred Brand 0%N/AQ:60
/30Days
NUCYNTA ER 250 MG TABLET ER 12H   3 Preferred Brand 0%N/AQ:60
/30Days
NUCYNTA ER 50 MG TABLET ER 12H   3 Preferred Brand 0%N/AQ:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NUEDEXTA 20; 10mg/1; mg/1   3 Preferred Brand 0%N/AP Q:60
/30Days
NUPLAZID 10 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:30
/30Days
NUPLAZID 34 MG CAPSULE   4 Non-Preferred Brand 25%N/AP Q:30
/30Days
NUTRILIPID 20 % EMULSION   2 Generic 0%0%P
NUZYRA 150 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/14Days
NYAMYC 100,000 UNITS/GM POWDER   2 Generic 0%0%Q:480
/30Days
NYSTATIN 100,000 UNIT/GM CREAM (g) [Pediaderm AF]   2 Generic 0%0%Q:240
/30Days
NYSTATIN 100,000 UNIT/GM OINTMENT [Nystex]   2 Generic 0%0%Q:240
/30Days
NYSTATIN 100,000 UNIT/GM POWDER [Pedi-Dri]   2 Generic 0%0%Q:480
/30Days
Nystatin 100000[USP'U]/mL   2 Generic 0%0%None
NYSTATIN 500,000 UNIT ORAL TAB   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NYSTOP 100,000 UNITS/GM POWDER   2 Generic 0%0%Q:480
/30Days

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.