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 P

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
PALIPERIDONE ER 1.5 MG TABLET ER 24 [Invega]   2 Generic 0%0%P Q:30
/30Days
PALIPERIDONE ER 3 MG TABLET ER 24 [Invega]   2 Generic 0%0%P Q:30
/30Days
PALIPERIDONE ER 6 MG TABLET ER 24 [Invega]   2 Generic 0%0%P Q:60
/30Days
PALIPERIDONE ER 9 MG TABLET ER 24 [Invega]   2 Generic 0%0%P Q:30
/30Days
PALYNZIQ 10 MG/0.5 ML SYRINGE   5 Specialty Tier 25%N/AP
PALYNZIQ 2.5 MG/0.5 ML SYRINGE   5 Specialty Tier 25%N/AP
PALYNZIQ 20 MG/ML SYRINGE   5 Specialty Tier 25%N/AP
PANTOPRAZOLE SOD DR 20 MG TAB   1 Preferred Generic 0%0%None
PANTOPRAZOLE SOD DR 40 MG TAB   1 Preferred Generic 0%0%None
PANZYGA 10% (1 G/10 ML) VIAL   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PANZYGA 10% (10 G/100 ML) VIAL   5 Specialty Tier 25%N/AP
PANZYGA 10% (2.5 G/25 ML) VIAL   5 Specialty Tier 25%N/AP
PANZYGA 10% (20 G/200 ML) VIAL   5 Specialty Tier 25%N/AP
PANZYGA 10% (30 G/300 ML) VIAL   5 Specialty Tier 25%N/AP
PANZYGA 10% (5 G/50 ML) VIAL   5 Specialty Tier 25%N/AP
PARICALCITOL 1 MCG CAPSULE [Zemplar]   2 Generic 0%0%None
PARICALCITOL 2 MCG CAPSULE [Zemplar]   2 Generic 0%0%None
PARICALCITOL 4 MCG CAPSULE [Zemplar]   2 Generic 0%0%None
PAROMOMYCIN 250 MG CAPSULE   4 Non-Preferred Brand 25%N/ANone
PAROXETINE ER 12.5 MG TABLET ER 24H [Paxil CR]   2 Generic 0%0%None
PAROXETINE ER 25 MG TABLET ER 24H [Paxil CR]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PAROXETINE ER 37.5 MG TABLET ER 24H [Paxil CR]   2 Generic 0%0%None
PAROXETINE HCL 10 MG TABLET   1 Preferred Generic 0%0%None
PAROXETINE HCL 20 MG TABLET   1 Preferred Generic 0%0%None
PAROXETINE HCL 30 MG TABLET   1 Preferred Generic 0%0%None
PAROXETINE HCL 40 MG TABLET   1 Preferred Generic 0%0%None
PASER GRANULES 4GM PACKET   3 Preferred Brand 0%N/ANone
PAXIL ORAL SUSPENSION 10 MG/5ML   4 Non-Preferred Brand 25%N/ANone
PEDVAXHIB VACCINE VIAL   3 Preferred Brand 0%N/ANone
PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte]   1 Preferred Generic 0%0%None
PEG-3350 AND ELECTROLYTES SOLUTION SOLUTION RECON   1 Preferred Generic 0%0%None
PEGANONE 250 MG TABLET   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS   5 Specialty Tier 25%N/ANone
PEGASYS INJECTION   5 Specialty Tier 25%N/ANone
PEGASYS PROCLICK 180 MCG/0.5   5 Specialty Tier 25%N/ANone
PEMAZYRE 13.5 MG TABLET   5 Specialty Tier 25%N/AP Q:14
/21Days
PEMAZYRE 4.5 MG TABLET   5 Specialty Tier 25%N/AP Q:14
/21Days
PEMAZYRE 9 MG TABLET   5 Specialty Tier 25%N/AP Q:14
/21Days
PENICILLAMINE 250 MG TABLET [Depen]   2 Generic 0%0%None
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM   2 Generic 0%0%None
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM   2 Generic 0%0%None
PENICILLIN G PROCAINE 1200000UNT 2ML CTG   3 Preferred Brand 0%N/ANone
Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PENICILLIN GK 20 MILLION UNIT   2 Generic 0%0%None
PENICILLIN V POTASSIUM 250MG/5ML LIQUID   1 Preferred Generic 0%0%None
PENICILLIN VK 125 MG/5 ML SOLUTION   1 Preferred Generic 0%0%None
PENICILLIN VK 250 MG TABLET   1 Preferred Generic 0%0%None
PENICILLIN VK 500 MG TABLET [Veetids]   1 Preferred Generic 0%0%None
PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent]   2 Generic 0%0%P
PENTAMIDINE 300 MG VIAL [Pentam]   2 Generic 0%0%None
PENTOXIFYLLINE 400MG TABLET SA   1 Preferred Generic 0%0%None
PERFOROMIST 20MCG/2ML VIAL NEBULIZER   4 Non-Preferred Brand 25%N/AP
PERINDOPRIL ERBUMINE 2 MG TAB   2 Generic 0%0%None
PERINDOPRIL ERBUMINE 4 MG TAB   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PERINDOPRIL ERBUMINE 8 MG TAB   2 Generic 0%0%None
PERMETHRIN 5% CREAM (G) [Elimite]   2 Generic 0%0%None
PERPHEN-AMITRIP 2 MG-10 MG TAB   2 Generic 0%0%None
PERPHEN-AMITRIP 2 MG-25 MG TAB   2 Generic 0%0%None
PERPHEN-AMITRIP 4 MG-25 MG TAB   2 Generic 0%0%None
PERPHENAZINE 16 MG TABLET [Trilafon]   2 Generic 0%0%None
PERPHENAZINE 2 MG TABLET [Trilafon]   2 Generic 0%0%None
PERPHENAZINE 4 MG TABLET [Trilafon]   2 Generic 0%0%None
PERPHENAZINE 8 MG TABLET [Trilafon]   2 Generic 0%0%None
PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT   5 Specialty Tier 25%N/ANone
PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PEXEVA 10 MG TABLET   4 Non-Preferred Brand 25%N/ANone
PEXEVA 20 MG TABLET   4 Non-Preferred Brand 25%N/ANone
PEXEVA 30 MG TABLET   4 Non-Preferred Brand 25%N/ANone
PEXEVA 40 MG TABLET   4 Non-Preferred Brand 25%N/ANone
PHENELZINE SULFATE 15 MG TABLET [Nardil]   2 Generic 0%0%None
Phenobarbital 100mg/1   2 Generic 0%0%None
PHENOBARBITAL 15 MG TABLET   2 Generic 0%0%None
PHENOBARBITAL 16.2 MG TABLET   2 Generic 0%0%None
PHENOBARBITAL 20 MG/5 ML ELIX   2 Generic 0%0%None
PHENOBARBITAL 30 MG TABLET   2 Generic 0%0%None
PHENOBARBITAL 32.4 MG TABLET   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Phenobarbital 60mg/1   2 Generic 0%0%None
PHENOBARBITAL 64.8 MG TABLET   2 Generic 0%0%None
PHENOBARBITAL 97.2 MG TABLET   2 Generic 0%0%None
PHENOXYBENZAMINE HCL 10 MG CAPSULE [Dibenzyline]   2 Generic 0%0%None
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin]   2 Generic 0%0%None
PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin]   2 Generic 0%0%None
PHENYTOIN SOD EXT 100 MG CAP   1 Preferred Generic 0%0%None
PHENYTOIN SOD EXT 200 MG CAP   2 Generic 0%0%None
PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek]   2 Generic 0%0%None
Phoslyra 667mg/5mL 1 BOTTLE per CARTON / 473 mL in 1 BOTTLE   3 Preferred Brand 0%N/ANone
PHOSPHOLINE IODIDE 0.125% 6.25MG   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PICATO 0.015% GEL   4 Non-Preferred Brand 25%N/AQ:3
/10Days
PICATO 0.05% GEL   4 Non-Preferred Brand 25%N/AQ:2
/10Days
PIFELTRO 100 MG TABLET   5 Specialty Tier 25%N/ANone
PILOCARPINE 1% EYE DROPS [Pilocar]   2 Generic 0%0%None
PILOCARPINE 2% EYE DROPS [Pilocar]   2 Generic 0%0%None
PILOCARPINE 4% EYE DROPS [Pilocar]   2 Generic 0%0%None
PILOCARPINE HCL 5 MG TABLET [Salagen]   2 Generic 0%0%None
PILOCARPINE HCL 7.5 MG TABLET [Salagen]   2 Generic 0%0%None
PIMECROLIMUS 1% CREAM (g) [Elidel]   2 Generic 0%0%None
PIMOZIDE 1 MG TABLET [Orap]   3 Preferred Brand 0%N/ANone
PIMOZIDE 2 MG TABLET [Orap]   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PIMTREA 28 DAY TABLET   2 Generic 0%0%None
PINDOLOL 10 MG TABLET   2 Generic 0%0%None
PINDOLOL 5 MG TABLET [Visken]   2 Generic 0%0%None
PIOGLITAZONE HCL 15 MG TABLET [Actos]   1 Preferred Generic 0%0%None
PIOGLITAZONE HCL 30 MG TABLET [Actos]   1 Preferred Generic 0%0%None
PIOGLITAZONE HCL 45 MG TABLET [Actos]   1 Preferred Generic 0%0%None
PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn]   2 Generic 0%0%None
PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn]   2 Generic 0%0%None
PIPERACIL-TAZOBACT 4.5 GM VIAL   2 Generic 0%0%None
PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn]   2 Generic 0%0%None
PIQRAY 200 MG DAILY DOSE TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PIQRAY 250 MG DAILY DOSE TABLET   5 Specialty Tier 25%N/AP Q:60
/30Days
PIQRAY 300 MG DAILY DOSE TABLET   5 Specialty Tier 25%N/AP Q:60
/30Days
PIRMELLA 1-35 28 TABLET   2 Generic 0%0%None
PIROXICAM 10 MG CAPSULE   2 Generic 0%0%None
PIROXICAM 20 MG CAPSULE [Feldene]   2 Generic 0%0%None
PLASMA-LYTE 148 IV SOLUTION   3 Preferred Brand 0%N/ANone
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;   3 Preferred Brand 0%N/ANone
PLEGRIDY 125 MCG/0.5 ML PEN   5 Specialty Tier 25%N/ANone
PLEGRIDY 125 MCG/0.5 ML SYRING   5 Specialty Tier 25%N/ANone
PLEGRIDY PEN INJ STARTER PACK   5 Specialty Tier 25%N/ANone
PLEGRIDY SYRINGE STARTER PACK   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PODOFILOX 0.5% TOPICAL SOLUTION [Condylox]   2 Generic 0%0%None
POLYMYXIN B SULFATE VIAL   2 Generic 0%0%None
POLYMYXIN B-TMP EYE DROPS   1 Preferred Generic 0%0%Q:10
/7Days
POMALYST 1 MG CAPSULE   5 Specialty Tier 25%N/AP
POMALYST 2 MG CAPSULE   5 Specialty Tier 25%N/AP
POMALYST 3 MG CAPSULE   5 Specialty Tier 25%N/AP
POMALYST 4 MG CAPSULE   5 Specialty Tier 25%N/AP
PORTIA 0.15-0.03 TABLET   2 Generic 0%0%None
POSACONAZOLE DR 100 MG TABLET [Noxafil]   2 Generic 0%0%P
Potassium Chloride 2 MEQ/ML Injectable Solution   2 Generic 0%0%None
Potassium Chloride 8 MEQ Extended Release Oral Tablet   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG   2 Generic 0%0%None
Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i   3 Preferred Brand 0%N/ANone
POTASSIUM CITRATE ER 10 MEQ TB   2 Generic 0%0%None
POTASSIUM CITRATE ER 15 MEQ TABLET   2 Generic 0%0%None
POTASSIUM CITRATE ER 5 MEQ TAB   2 Generic 0%0%None
POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK   2 Generic 0%0%None
POTASSIUM CL 10% (20 MEQ/15ML) LIQUID [Kay Ciel]   2 Generic 0%0%None
POTASSIUM CL 20 MEQ PACKET [Klor-Con]   2 Generic 0%0%None
POTASSIUM CL 20 MEQ-0.45% NACL IV SOLUTION   2 Generic 0%0%None
POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK   2 Generic 0%0%None
POTASSIUM CL 20% (40 MEQ/15ML) LIQUID [Kaon-CL]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CL 40 MEQ/100 ML SOL PIGGYBACK   2 Generic 0%0%None
POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP]   2 Generic 0%0%None
POTASSIUM CL ER 10 MEQ CAPSULE ER [Micro-K Extencaps]   1 Preferred Generic 0%0%None
POTASSIUM CL ER 10 MEQ TABLET   1 Preferred Generic 0%0%None
POTASSIUM CL ER 10 MEQ TABLET [Klotrix]   1 Preferred Generic 0%0%None
POTASSIUM CL ER 20 MEQ TABLET   1 Preferred Generic 0%0%None
Potassium cl er 20 meq tablet   2 Generic 0%0%None
POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps]   1 Preferred Generic 0%0%None
PRADAXA 110 MG CAPSULE   3 Preferred Brand 0%N/ANone
PRADAXA 150 MG CAPSULE   3 Preferred Brand 0%N/ANone
PRADAXA 75 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
PRALUENT 150 MG/ML PEN INJCTR   3 Preferred Brand 0%N/AP Q:2
/28Days
PRALUENT 75 MG/ML PEN INJCTR   3 Preferred Brand 0%N/AP Q:2
/28Days
PRAMIPEXOLE 0.125 MG TABLET [Mirapex]   1 Preferred Generic 0%0%None
PRAMIPEXOLE 0.25 MG TABLET [Mirapex]   1 Preferred Generic 0%0%None
PRAMIPEXOLE 0.5 MG TABLET   1 Preferred Generic 0%0%None
PRAMIPEXOLE 0.75 MG TABLET   1 Preferred Generic 0%0%None
PRAMIPEXOLE 1 MG TABLET [Mirapex]   1 Preferred Generic 0%0%None
PRAMIPEXOLE 1.5 MG TABLET [Mirapex]   1 Preferred Generic 0%0%None
PRAMIPEXOLE ER 0.375 MG TABLET ER 24H [Mirapex ER]   2 Generic 0%0%None
PRAMIPEXOLE ER 0.75 MG TABLET   2 Generic 0%0%None
PRAMIPEXOLE ER 1.5 MG TABLET ER 24H [Mirapex ER]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRAMIPEXOLE ER 2.25 MG TABLET ER 24H [Mirapex ER]   2 Generic 0%0%None
PRAMIPEXOLE ER 3 MG TABLET ER 24H [Mirapex ER]   2 Generic 0%0%None
PRAMIPEXOLE ER 3.75 MG TABLET   2 Generic 0%0%None
PRAMIPEXOLE ER 4.5 MG TABLET ER 24H [Mirapex ER]   2 Generic 0%0%None
PRASUGREL 10 MG TABLET [Effient]   1 Preferred Generic 0%0%None
PRASUGREL 5 MG TABLET [Effient]   1 Preferred Generic 0%0%None
PRAVASTATIN SODIUM 10 MG TABLET [Pravachol]   1 Preferred Generic 0%0%None
PRAVASTATIN SODIUM 20 MG TAB   1 Preferred Generic 0%0%None
PRAVASTATIN SODIUM 40 MG TABLET [Pravachol]   1 Preferred Generic 0%0%None
PRAVASTATIN SODIUM 80 MG TABLET [Pravachol]   1 Preferred Generic 0%0%None
PRAZIQUANTEL 600 MG TABLET [Biltricide]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRAZOSIN 1 MG CAPSULE   1 Preferred Generic 0%0%None
PRAZOSIN 2 MG CAPSULE [Minipress]   1 Preferred Generic 0%0%None
PRAZOSIN 5 MG CAPSULE [Minipress]   1 Preferred Generic 0%0%None
PRED FORTE 1% EYE DROPS   4 Non-Preferred Brand 25%N/ANone
PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR   3 Preferred Brand 0%N/ANone
PRED MILD 0.12% EYE DROPS   3 Preferred Brand 0%N/ANone
PRED-G S.O.P. EYE OINTMENT   4 Non-Preferred Brand 25%N/ANone
Prednicarbate 0.1% cream   3 Preferred Brand 0%N/ANone
PREDNICARBATE 0.1% OINTMENT [Dermatop]   3 Preferred Brand 0%N/ANone
PREDNISOLONE 10 MG/5 ML SOLUTION   2 Generic 0%0%P
PREDNISOLONE 15 MG/5 ML SOLUTION   2 Generic 0%0%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREDNISOLONE 20 MG/5 ML SOLUTION [Veripred-20]   2 Generic 0%0%P
PREDNISOLONE AC 1% EYE DROP   2 Generic 0%0%None
PREDNISOLONE ODT 10 MG TABLET RAPDIS [Orapred ODT]   2 Generic 0%0%P
PREDNISOLONE ODT 15 MG TABLET RAPDIS [Orapred ODT]   2 Generic 0%0%P
PREDNISOLONE ODT 30 MG TABLET RAPDIS [Orapred ODT]   2 Generic 0%0%P
PREDNISOLONE SOD 1% EYE DROP   2 Generic 0%0%None
PREDNISOLONE SOD PH 25 MG/5 ML   4 Non-Preferred Brand 25%N/AP
PREDNISOLONE SODIUM PHOSPHATE 5MG /5ML ORAL SOLUTION   2 Generic 0%0%P
PREDNISONE 1 MG TABLET   1 Preferred Generic 0%0%P
PREDNISONE 10 MG TABLET [Sterapred DS]   1 Preferred Generic 0%0%P
PREDNISONE 2.5 MG TABLET   1 Preferred Generic 0%0%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREDNISONE 20 MG TABLET [Predone]   1 Preferred Generic 0%0%P
PREDNISONE 5 MG TABLET [Sterapred]   1 Preferred Generic 0%0%P
PREDNISONE 5 MG/5 ML SOLUTION   2 Generic 0%0%P
PREDNISONE 50MG TABLET   1 Preferred Generic 0%0%P
PREDNISONE 5MG/ML SOLUTION   3 Preferred Brand 0%N/AP
Prefest 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK   4 Non-Preferred Brand 25%N/ANone
PREGABALIN 100 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 150 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 20 MG/ML SOLUTION [Lyrica]   2 Generic 0%0%None
PREGABALIN 200 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 225 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREGABALIN 25 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 300 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 50 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREGABALIN 75 MG CAPSULE [Lyrica]   1 Preferred Generic 0%0%None
PREMARIN 0.3 MG TABLET   3 Preferred Brand 0%N/ANone
PREMARIN 0.45MG TABLET   3 Preferred Brand 0%N/ANone
PREMARIN 0.625 MG TABLET   3 Preferred Brand 0%N/ANone
Premarin 0.625mg/g   3 Preferred Brand 0%N/ANone
PREMARIN 0.9MG TABLET   3 Preferred Brand 0%N/ANone
PREMARIN 1.25 MG TABLET   3 Preferred Brand 0%N/ANone
PREMASOL 10% IV SOLUTION   4 Non-Preferred Brand 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREMPHASE 0.625-5 MG TABLET   3 Preferred Brand 0%N/ANone
PREMPRO 0.3 MG-1.5 MG TABLET #28 EA   3 Preferred Brand 0%N/ANone
PREMPRO 0.45-1.5 MG TABLET 28 EA   3 Preferred Brand 0%N/ANone
PREMPRO 0.625-5 MG TABLET   3 Preferred Brand 0%N/ANone
Prempro 0.625; 2.5mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, SUGAR COATED per BLISTER PACK   3 Preferred Brand 0%N/ANone
PREVALITE PACKET   2 Generic 0%0%None
PREVIFEM TABLET [VyLibra]   2 Generic 0%0%None
PREVYMIS 240 MG   5 Specialty Tier 25%N/AP Q:30
/30Days
PREVYMIS 480 MG   5 Specialty Tier 25%N/AP Q:30
/30Days
PREZCOBIX 800 MG-150 MG TABLET   5 Specialty Tier 25%N/ANone
PREZISTA 100 MG/ML SUSPENSION   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREZISTA 150MG TABLETS   3 Preferred Brand 0%N/ANone
PREZISTA 800 MG TABLET   5 Specialty Tier 25%N/ANone
PREZISTA TABLET 600MG   5 Specialty Tier 25%N/ANone
PREZISTA TABLET 75MG   3 Preferred Brand 0%N/ANone
PRIFTIN 150 MG TABLET   4 Non-Preferred Brand 25%N/ANone
PRIMAQUINE 26.3 MG TABLET [Primaquine]   1 Preferred Generic 0%0%None
PRIMIDONE 250 MG TABLET [Mysoline]   1 Preferred Generic 0%0%None
PRIMIDONE 50 MG TABLET [Mysoline]   1 Preferred Generic 0%0%None
PRIVIGEN 10% VIAL   5 Specialty Tier 25%N/AP
PROBENECID 500 MG TABLET   2 Generic 0%0%None
PROBENECID-COLCHICINE TABLET   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0   4 Non-Preferred Brand 25%N/AP
PROCENTRA 5 MG/5 ML SOLUTION   2 Generic 0%0%None
PROCHLORPERAZINE 10 MG TAB   1 Preferred Generic 0%0%None
PROCHLORPERAZINE 5 MG TABLET   1 Preferred Generic 0%0%None
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX   2 Generic 0%0%None
PROCTO-MED HC 2.5% CREAM   2 Generic 0%0%None
procto-pak 1% cream   2 Generic 0%0%None
PROCTOSOL-HC 2.5% CREAM   2 Generic 0%0%None
PROCTOZONE-HC 2.5% CREAM   2 Generic 0%0%None
PROGESTERONE 100 MG CAPSULE   2 Generic 0%0%None
PROGESTERONE 200 MG CAPSULE [Prometrium]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROGRAF 0.2 MG GRANULE PACKET   4 Non-Preferred Brand 25%N/AP
PROGRAF 1 MG GRANULE PACKET   4 Non-Preferred Brand 25%N/AP
PROLASTIN C 1,000 MG VIAL   5 Specialty Tier 25%N/ANone
PROLENSA 0.07% EYE DROPS   4 Non-Preferred Brand 25%N/ANone
PROLIA 60MG/ML INJECTION   4 Non-Preferred Brand 25%N/AP
PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK   5 Specialty Tier 25%N/AP
PROMACTA 12.5 MG TABLET   5 Specialty Tier 25%N/AP
PROMACTA 25 MG SUSPENSION POWDER PACK   5 Specialty Tier 25%N/AP
PROMACTA 25 MG TABLET   5 Specialty Tier 25%N/AP
PROMACTA 50 MG TABLET   5 Specialty Tier 25%N/AP
PROMACTA 75 MG TABLET   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROMETHAZINE 12.5 MG TABLET   1 Preferred Generic 0%0%None
PROMETHAZINE 25 MG TABLET   1 Preferred Generic 0%0%None
PROMETHAZINE 50 MG TABLET   1 Preferred Generic 0%0%None
PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain]   2 Generic 0%0%None
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX   2 Generic 0%0%None
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX   2 Generic 0%0%None
PROMETHAZINE-PHENYLEPHRINE SYRUP [Prometh VC Plain]   2 Generic 0%0%None
PROMETHEGAN 25MG SUPP   2 Generic 0%0%None
PROMETHEGAN 50MG SUPPOS   3 Preferred Brand 0%N/ANone
PROPAFENONE HCL 150 MG TABLET [Rythmol]   2 Generic 0%0%None
PROPAFENONE HCL 225MG TABLET   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROPAFENONE HCL 300 MG TABLET [Rythmol]   2 Generic 0%0%None
PROPAFENONE HCL ER 225 MG CAP   2 Generic 0%0%None
PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE   2 Generic 0%0%None
PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE   2 Generic 0%0%None
PROPARACAINE 0.5% EYE DROPS [Parcaine]   2 Generic 0%0%None
PROPRANOLOL 10 MG TABLET   1 Preferred Generic 0%0%None
PROPRANOLOL 20 MG TABLET   1 Preferred Generic 0%0%None
PROPRANOLOL 20MG/5ML TUBEX   2 Generic 0%0%None
PROPRANOLOL 40 MG TABLET   1 Preferred Generic 0%0%None
PROPRANOLOL 40MG/5ML TUBEX   2 Generic 0%0%None
PROPRANOLOL 60 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
PROPRANOLOL 80 MG TABLET [Inderal]   1 Preferred Generic 0%0%None
PROPRANOLOL ER 120 MG CAPSULE   2 Generic 0%0%None
PROPRANOLOL ER 160 MG CAPSULE   2 Generic 0%0%None
PROPRANOLOL ER 60 MG CAPSULE   2 Generic 0%0%None
PROPRANOLOL ER 80 MG CAPSULE   2 Generic 0%0%None
PROPRANOLOL/HCTZ 40/25 TABLET   2 Generic 0%0%None
PROPRANOLOL/HCTZ 80/25 TABLET   2 Generic 0%0%None
PROPYLTHIOURACIL 50 MG TABLET   2 Generic 0%0%None
PROQUAD VIAL   3 Preferred Brand 0%N/ANone
PROSOL 20% INJECTION   4 Non-Preferred Brand 25%N/AP
PROTRIPTYLINE HCL 10 MG TABLET [Vivactil]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROTRIPTYLINE HCL 5 MG TABLET [Vivactil]   2 Generic 0%0%None
PULMOZYME 1MG/ML AMPUL   5 Specialty Tier 25%N/AP
PURIXAN 20 MG/ML ORAL SUSPENSION   4 Non-Preferred Brand 25%N/ANone
PYLERA CAPSULE   4 Non-Preferred Brand 25%N/ANone
PYRAZINAMIDE 500 MG TABLET   2 Generic 0%0%None
PYRIDOSTIGMINE 60 MG/5 ML SOLUTION SYRUP [Mestinon]   2 Generic 0%0%None
PYRIDOSTIGMINE BR 60 MG TABLET   2 Generic 0%0%None
PYRIDOSTIGMINE BR ER 180 MG TAB   2 Generic 0%0%None

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.