Q1GROUP LLC | Q1Medicare.com - a non-government resource for the Medicare community
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

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 (712)
Tier 2 (1772)
Tier 3 (484)
Tier 4 (414)
Tier 5 (596)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
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)
Benefit Details           
The SOLIS SPF 002 (HMO D-SNP) (H0982-002-0)
Formulary Drugs Starting with the Letter B

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

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Bacitracin 500 unit/gm Eye Ointment   2 Generic 0%0%None
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT   2 Generic 0%0%Q:7
/7Days
BACLOFEN 10 MG TABLET   1 Preferred Generic 0%0%None
BACLOFEN 20 MG TABLET [Lioresal]   1 Preferred Generic 0%0%None
BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal]   2 Generic 0%0%None
BALVERSA 3 MG TABLET   5 Specialty Tier 25%N/AP Q:60
/30Days
BALVERSA 4 MG TABLET   5 Specialty Tier 25%N/AP Q:60
/30Days
BALVERSA 5 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK   2 Generic 0%0%None
Banzel 200mg/1   3 Preferred Brand 0%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BANZEL 400MG TABLET   3 Preferred Brand 0%N/AP
Banzel 40mg/mL   3 Preferred Brand 0%N/AP
BAQSIMI 3 MG SPRAY TWO PACK   3 Preferred Brand 0%N/AQ:2
/7Days
BAXDELA 450 MG TABLET   3 Preferred Brand 0%N/AP Q:60
/30Days
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL   3 Preferred Brand 0%N/ANone
BENAZEPRIL HCL 10 MG TABLET   1 Preferred Generic 0%0%None
BENAZEPRIL HCL 20 MG TABLET   1 Preferred Generic 0%0%None
BENAZEPRIL HCL 40 MG TABLET   1 Preferred Generic 0%0%None
BENAZEPRIL HCL 5 MG TABLET   1 Preferred Generic 0%0%None
BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT]   2 Generic 0%0%None
BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT]   2 Generic 0%0%None
BENAZEPRIL-HCTZ 5-6.25 MG TABLET [Lotensin HCT]   2 Generic 0%0%None
BENLYSTA 200 MG/ML AUTOINJECT   5 Specialty Tier 25%N/AP Q:4
/28Days
BENLYSTA 200 MG/ML SYRINGE   5 Specialty Tier 25%N/AP Q:4
/28Days
BENZNIDAZOLE 100 MG TABLET   3 Preferred Brand 0%N/AP
BENZNIDAZOLE 12.5 MG TABLET   3 Preferred Brand 0%N/AP
BENZTROPINE MES 0.5 MG TABLET [Cogentin]   1 Preferred Generic 0%0%None
BENZTROPINE MES 1 MG TABLET [Cogentin]   1 Preferred Generic 0%0%None
BENZTROPINE MES 2 MG TABLET [Cogentin]   1 Preferred Generic 0%0%None
BEPREVE 1.5% EYE DROPS   4 Non-Preferred Brand 25%N/ANone
BERINERT 500 UNIT KIT   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE   2 Generic 0%0%None
BETAMETHASONE DP 0.05% LOTION   2 Generic 0%0%None
BETAMETHASONE DP 0.05% OINTMENT [Maxivate]   2 Generic 0%0%None
BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak]   2 Generic 0%0%None
BETAMETHASONE DP AUG 0.05% GEL   2 Generic 0%0%None
BETAMETHASONE DP AUG 0.05% LOTION   2 Generic 0%0%None
BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene]   2 Generic 0%0%None
BETAMETHASONE VA 0.1% CREAM (G) [Valisone]   2 Generic 0%0%None
BETAMETHASONE VALER 0.1% LOTION [Valisone]   2 Generic 0%0%None
BETAMETHASONE VALER 0.1% OINTMENT [Valisone]   2 Generic 0%0%None
BETAXOLOL 10 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
BETAXOLOL 20 MG TABLET   1 Preferred Generic 0%0%None
BETAXOLOL HCL 0.5% EYE DROPS   2 Generic 0%0%None
BETHANECHOL 10 MG TABLET   1 Preferred Generic 0%0%None
BETHANECHOL 25 MG TABLET   1 Preferred Generic 0%0%None
BETHANECHOL 5 MG TABLET   1 Preferred Generic 0%0%None
BETHANECHOL 50 MG TABLET   1 Preferred Generic 0%0%None
BETIMOL 0.25% EYE DROPS   4 Non-Preferred Brand 25%N/ANone
BETIMOL 0.5% EYE DROPS   3 Preferred Brand 0%N/ANone
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT   4 Non-Preferred Brand 25%N/ANone
BEXAROTENE 75 MG CAPSULE [Targretin]   2 Generic 0%0%P
BEXSERO PREFILLED SYRINGE   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BICALUTAMIDE 50 MG TABLET   1 Preferred Generic 0%0%None
BICILL LA PFS 600MU 1ML PED   3 Preferred Brand 0%N/ANone
BICILLIN C-R 1.2MM UNITS SYRINGE 2ML x 10   3 Preferred Brand 0%N/ANone
BICILLIN C-R 900/300 SYRINGE 2ML x 10   3 Preferred Brand 0%N/ANone
BICILLIN LA PFS 1200MU 2ML   3 Preferred Brand 0%N/ANone
BICILLIN LA. 600000UNIT/ML 1ML   3 Preferred Brand 0%N/ANone
BIDIL TABLET   3 Preferred Brand 0%N/ANone
BIKTARVY 50-200-25 MG TABLET   5 Specialty Tier 25%N/ANone
BIMATOPROST 0.03% EYE DROPS [Lumigan]   2 Generic 0%0%Q:5
/30Days
BISOPROLOL FUMARATE 10 MG TABLET   1 Preferred Generic 0%0%None
BISOPROLOL FUMARATE 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
BISOPROLOL-HCTZ 10-6.25 MG TABLET   1 Preferred Generic 0%0%None
BISOPROLOL-HCTZ 2.5-6.25 MG TABLET   1 Preferred Generic 0%0%None
BISOPROLOL-HCTZ 5-6.25 MG TABLET   1 Preferred Generic 0%0%None
BIVIGAM 10% VIAL [Panzyga]   5 Specialty Tier 25%N/AP
BLEPHAMIDE 10-0.2% EYE OINTMENT   4 Non-Preferred Brand 25%N/ANone
BLEPHAMIDE EYE DROPS   4 Non-Preferred Brand 25%N/ANone
BLISOVI 24 FE TABLET [Tarina Fe 1/20]   2 Generic 0%0%None
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30]   2 Generic 0%0%None
BOOSTRIX TDAP VACCINE SYRINGE   3 Preferred Brand 0%N/ANone
BOOSTRIX TDAP VACCINE VIAL   3 Preferred Brand 0%N/ANone
BOSENTAN 125 MG TABLET [Tracleer]   2 Generic 0%0%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BOSENTAN 62.5 MG TABLET [Tracleer]   2 Generic 0%0%P Q:60
/30Days
BOSULIF 100 MG TABLET   5 Specialty Tier 25%N/AP
BOSULIF 400 MG TABLET   5 Specialty Tier 25%N/AP
BOSULIF 500 MG TABLET   5 Specialty Tier 25%N/AP
BRAFTOVI 75 MG CAPSULE   5 Specialty Tier 25%N/AP Q:180
/30Days
BREO ELLIPTA 100-25 MCG INH   3 Preferred Brand 0%N/AQ:60
/30Days
BREO ELLIPTA 200-25 MCG INH   3 Preferred Brand 0%N/AQ:60
/30Days
BREZTRI AEROSPHERE INHALER HFA AER AD   3 Preferred Brand 0%N/AQ:11
/30Days
BRIELLYN TABLET   2 Generic 0%0%None
BRILINTA 60 MG TABLET   4 Non-Preferred Brand 25%N/ANone
BRILINTA 90mg/1 60 TABLET BOTTLE   4 Non-Preferred Brand 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BRIMONIDINE 0.2% EYE DROPS [Alphagan]   2 Generic 0%0%None
BRIMONIDINE TARTRATE 0.15% DROPS   2 Generic 0%0%None
BRINZOLAMIDE 1% EYE DROPS EYE DROPPER [Azopt]   2 Generic 0%0%None
BRIVIACT 10 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:60
/30Days
BRIVIACT 10 MG/ML ORAL SOLUTION   4 Non-Preferred Brand 25%N/AP
BRIVIACT 100 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:60
/30Days
BRIVIACT 25 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:60
/30Days
BRIVIACT 50 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:60
/30Days
BRIVIACT 75 MG TABLET   4 Non-Preferred Brand 25%N/AP Q:60
/30Days
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom]   2 Generic 0%0%None
BROMOCRIPTINE 2.5 MG TABLET [Parlodel]   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BROMOCRIPTINE 5 MG CAPSULE [Parlodel]   2 Generic 0%0%None
BROVANA 15MCG/2ML VIAL NEBULIZER   4 Non-Preferred Brand 25%N/AP
BRUKINSA 80 MG CAPSULE   5 Specialty Tier 25%N/AP Q:120
/30Days
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   2 Generic 0%0%P Q:120
/30Days
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort]   2 Generic 0%0%P Q:120
/30Days
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort]   2 Generic 0%0%P Q:120
/30Days
BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC]   2 Generic 0%0%None
BUDESONIDE ER 9 MG TABLETDR - ER [UCERIS]   2 Generic 0%0%P Q:30
/30Days
BUMETANIDE 0.5 MG TABLET [Bumex]   2 Generic 0%0%None
BUMETANIDE 1 MG TABLET [Bumex]   2 Generic 0%0%None
BUMETANIDE 1 MG/4 ML VIAL   2 Generic 0%0%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUMETANIDE 2 MG TABLET [Bumex]   2 Generic 0%0%None
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone]   1 Preferred Generic 0%0%None
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone]   1 Preferred Generic 0%0%None
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone]   1 Preferred Generic 0%0%None
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone]   1 Preferred Generic 0%0%None
BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone]   1 Preferred Generic 0%0%None
BUPRENORPHINE 10 MCG/HR PATCH [Butrans]   2 Generic 0%0%Q:4
/28Days
BUPRENORPHINE 15 MCG/HR PATCH [Butrans]   2 Generic 0%0%Q:4
/28Days
BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex]   1 Preferred Generic 0%0%None
BUPRENORPHINE 20 MCG/HR PATCH [Butrans]   2 Generic 0%0%Q:4
/28Days
BUPRENORPHINE 5 MCG/HR PATCH [Butrans]   2 Generic 0%0%Q:4
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans]   2 Generic 0%0%Q:4
/28Days
BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex]   1 Preferred Generic 0%0%None
BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone]   1 Preferred Generic 0%0%None
BUPROPION HCL 100 MG TABLET   1 Preferred Generic 0%0%None
BUPROPION HCL 75 MG TABLET   1 Preferred Generic 0%0%None
BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR]   1 Preferred Generic 0%0%None
BUPROPION HCL SR 150 MG TABLET   1 Preferred Generic 0%0%None
BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR]   1 Preferred Generic 0%0%None
BUPROPION HCL SR 200 MG TABLET   1 Preferred Generic 0%0%None
BUPROPION HCL XL 150 MG TABLET   1 Preferred Generic 0%0%None
BUPROPION HCL XL 300 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
BUSPIRONE HCL 15 MG TABLET   1 Preferred Generic 0%0%None
BUSPIRONE HCL 30 MG TABLET   1 Preferred Generic 0%0%None
BUSPIRONE HCL 5 MG TABLET   1 Preferred Generic 0%0%None
BUSPIRONE HCL 7.5 MG TABLET   1 Preferred Generic 0%0%None
BUSPIRONE HYDROCHLORIDE 10 MG TABLET   1 Preferred Generic 0%0%None
BUTORPHANOL 10 MG/ML SPRAY [Stadol NS]   2 Generic 0%0%Q:10
/30Days
BYDUREON BCISE 2 MG AUTOINJECT   3 Preferred Brand 0%N/AQ:3
/28Days
BYETTA 10 MCG DOSE PEN INJ   4 Non-Preferred Brand 25%N/AQ:2
/30Days
BYETTA 5 MCG DOSE PEN INJ   4 Non-Preferred Brand 25%N/AQ:1
/30Days
Bystolic 10mg/1 30 TABLET BOTTLE   3 Preferred Brand 0%N/ANone
Bystolic 2.5mg/1 30 TABLET BOTTLE   3 Preferred Brand 0%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
BYSTOLIC 20 MG TABLET   3 Preferred Brand 0%N/ANone
Bystolic 5mg 30 TABLET BOTTLE   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 $4,130) 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 insulin copay is in green, example: $35.00, this Part D plan may offer particular forms of insulin as part of the Senior Savings Model.  The Senior Savings Model stipulates that some 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 September 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.