2022 Medicare Part D Plan Formulary Information |
SelectHealth Advantage Enhanced (HMO) (H1994-007-0)
Benefit Details
![Email Prescription and/or Health Benefit details for SelectHealth Advantage Enhanced (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) This plan covers select insulin pay $0-$35 copay.
See individual insulin cost-sharing below. |
The SelectHealth Advantage Enhanced (HMO) (H1994-007-0) Formulary Drugs Starting with the Letter S in Weber County, UT: CMS MA Region 23 which includes: UT
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Safyral 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in UT cover Safyral 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
SANTYL OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover SANTYL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SAPROPTERIN 100 MG POWDER PACK [KUVAN] ![Compare how all Medicare Part D PDP plans in UT cover SAPROPTERIN 100 MG POWDER PACK [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SAPROPTERIN 100 MG TABLET SOL [KUVAN] ![Compare how all Medicare Part D PDP plans in UT cover SAPROPTERIN 100 MG TABLET SOL [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SAPROPTERIN 500 MG POWDER PACK [KUVAN] ![Compare how all Medicare Part D PDP plans in UT cover SAPROPTERIN 500 MG POWDER PACK [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SAVAYSA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SAVAYSA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days |
SAVAYSA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SAVAYSA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days |
SAVAYSA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SAVAYSA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in UT cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in UT cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in UT cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in UT cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in UT cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SCEMBLIX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SCEMBLIX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SCEMBLIX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SCEMBLIX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:300 /30Days |
SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop] ![Compare how all Medicare Part D PDP plans in UT cover SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:10 /28Days |
SECUADO 3.8 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover SECUADO 3.8 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
SECUADO 5.7 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover SECUADO 5.7 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
SECUADO 7.6 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover SECUADO 7.6 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
SEGLUROMET 2.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SEGLUROMET 2.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEGLUROMET 2.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SEGLUROMET 2.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SEGLUROMET 7.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SEGLUROMET 7.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SEGLUROMET 7.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SEGLUROMET 7.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SELZENTRY 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:1800 /30Days |
SELZENTRY 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:120 /30Days |
SELZENTRY 75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SELZENTRY 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:120 /30Days |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in UT cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SERTRALINE 20 MG/ML ORAL CONC [Zoloft] ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE 20 MG/ML ORAL CONC [Zoloft].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:300 /30Days |
SERTRALINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HCL 25 MG TABLET [Zoloft] ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 25 MG TABLET [Zoloft].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SERTRALINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SERTRALINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SEVELAMER CARBONATE 800 MG TABLET [Renvela] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER CARBONATE 800 MG TABLET [Renvela].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SEVELAMER HCL 400 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER HCL 400 MG TABLET [RenaGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SEVELAMER HCL 800 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in UT cover SEVELAMER HCL 800 MG TABLET [RenaGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SHINGRIX VIAL KIT ![Compare how all Medicare Part D PDP plans in UT cover SHINGRIX VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SIGNIFOR 0.3 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in UT cover SIGNIFOR 0.3 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SIGNIFOR 0.6 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in UT cover SIGNIFOR 0.6 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SIGNIFOR 0.9 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in UT cover SIGNIFOR 0.9 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio] ![Compare how all Medicare Part D PDP plans in UT cover SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P Q:180 /30Days |
SILDENAFIL 20 MG TABLET [Revatio] ![Compare how all Medicare Part D PDP plans in UT cover SILDENAFIL 20 MG TABLET [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SILODOSIN 4 MG CAPSULE [Rapaflo] ![Compare how all Medicare Part D PDP plans in UT cover SILODOSIN 4 MG CAPSULE [Rapaflo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SILODOSIN 8 MG CAPSULE [Rapaflo] ![Compare how all Medicare Part D PDP plans in UT cover SILODOSIN 8 MG CAPSULE [Rapaflo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SILVER SULFADIAZINE 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover SILVER SULFADIAZINE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SIMBRINZA 1%-0.2% EYE DROPS EYE DROPPER ![Compare how all Medicare Part D PDP plans in UT cover SIMBRINZA 1%-0.2% EYE DROPS EYE DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:16 /30Days |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days |
SIMVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SIMVASTATIN 5 MG TABLET [Zocor] ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 5 MG TABLET [Zocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SIMVASTATIN 80 MG TABLET [Zocor] ![Compare how all Medicare Part D PDP plans in UT cover SIMVASTATIN 80 MG TABLET [Zocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIROLIMUS 1 MG/ML SOLUTION [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover SIROLIMUS 1 MG/ML SOLUTION [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in UT cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:188 /30Days |
SIRTURO 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIRTURO 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:1050 /30Days |
SITAVIG 50 MG BUCCAL TABLET MA ![Compare how all Medicare Part D PDP plans in UT cover SITAVIG 50 MG BUCCAL TABLET MA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
SIVEXTRO 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SIVEXTRO 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:6 /30Days |
SIVEXTRO 200 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SIVEXTRO 200 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:6 /30Days |
SKYRIZI 150 MG DOSE KIT-2 SYRINGEKIT ![Compare how all Medicare Part D PDP plans in UT cover SKYRIZI 150 MG DOSE KIT-2 SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /30Days |
SKYRIZI 150 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover SKYRIZI 150 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /28Days |
SKYRIZI 150 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover SKYRIZI 150 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /28Days |
SLYND 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SLYND 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE 0.45% SOLUTION IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.45% SOLUTION IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SODIUM CHLORIDE 0.9% IRRIG. ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.9% IRRIG..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | P |
SODIUM CHLORIDE 0.9% SOLUTION PGY VL PRT ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 0.9% SOLUTION PGY VL PRT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SODIUM CHLORIDE 3% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE 3% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in UT cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SODIUM PHENYLBUTYRATE POWDER [Buphenyl] ![Compare how all Medicare Part D PDP plans in UT cover SODIUM PHENYLBUTYRATE POWDER [Buphenyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SODIUM POLYSTYRENE SULF POWDER ![Compare how all Medicare Part D PDP plans in UT cover SODIUM POLYSTYRENE SULF POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa] ![Compare how all Medicare Part D PDP plans in UT cover SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
SOLIFENACIN 10 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in UT cover SOLIFENACIN 10 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SOLIFENACIN 5 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in UT cover SOLIFENACIN 5 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
SOLIQUA 100 UNIT-33 MCG/ML PEN ![Compare how all Medicare Part D PDP plans in UT cover SOLIQUA 100 UNIT-33 MCG/ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $135.00 | S Q:18 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOLTAMOX 20 MG/10 ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover SOLTAMOX 20 MG/10 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:90 /30Days |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SORAFENIB 200 MG TABLET [Nexavar] ![Compare how all Medicare Part D PDP plans in UT cover SORAFENIB 200 MG TABLET [Nexavar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:120 /30Days |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in UT cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL 120 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 120 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTALOL 240 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 240 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL AF 120 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL AF 120 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL AF 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL AF 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SOTALOL AF 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in UT cover SOTALOL AF 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SPINOSAD 0.9% TOPICAL SUSPENSION SUSPENSION [Natroba] ![Compare how all Medicare Part D PDP plans in UT cover SPINOSAD 0.9% TOPICAL SUSPENSION SUSPENSION [Natroba].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SPIRIVA 18 MCG CP-HANDIHALER ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA 18 MCG CP-HANDIHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days |
SPIRIVA RESPIMAT 1.25 MCG INH ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA RESPIMAT 1.25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:4 /30Days |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:4 /30Days |
SPIRONOLACTONE 100 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 100 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRONOLACTONE 25 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 25 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPIRONOLACTONE 50 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE 50 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide] ![Compare how all Medicare Part D PDP plans in UT cover SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SPRITAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:90 /30Days |
SPRITAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:90 /30Days |
SPRITAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:90 /30Days |
SPRITAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRITAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:90 /30Days |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SPS 15 GM/60 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover SPS 15 GM/60 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SRONYX 0.10-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SRONYX 0.10-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in UT cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
STEGLATRO 15 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover STEGLATRO 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
STEGLATRO 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover STEGLATRO 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /84Days |
STELARA 45 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover STELARA 45 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /28Days |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:2 /84Days |
STIOLTO RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover STIOLTO RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:84 /21Days |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in UT cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | P |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in UT cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | Q:30 /30Days |
STRIVERDI RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover STRIVERDI RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:4 /30Days |
SUCRAID 8500[iU]/mL ![Compare how all Medicare Part D PDP plans in UT cover SUCRAID 8500[iU]/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:354 /30Days |
SUCRALFATE 1 GM/10 ML ORAL SUSPENSION [Carafate] ![Compare how all Medicare Part D PDP plans in UT cover SUCRALFATE 1 GM/10 ML ORAL SUSPENSION [Carafate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULF-PRED 10-0.23% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover SULF-PRED 10-0.23% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULFACETAMIDE 10% EYE DROPS [Sulf-10] ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE 10% EYE DROPS [Sulf-10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULFACETAMIDE SOD 10% TOP SUSP ![Compare how all Medicare Part D PDP plans in UT cover SULFACETAMIDE SOD 10% TOP SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFADIAZINE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SULFADIAZINE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SULFAMETHOXAZOLE-TMP ORAL SUSPENSION [Sultrex Pediatric] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP ORAL SUSPENSION [Sultrex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SULFAMETHOXAZOLE-TMP SS TABLET [Septra] ![Compare how all Medicare Part D PDP plans in UT cover SULFAMETHOXAZOLE-TMP SS TABLET [Septra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SULFASALAZINE 500 MG TABLET [Sulfazine] ![Compare how all Medicare Part D PDP plans in UT cover SULFASALAZINE 500 MG TABLET [Sulfazine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULFASALAZINE DR 500 MG TABLET [Sulfazine EC] ![Compare how all Medicare Part D PDP plans in UT cover SULFASALAZINE DR 500 MG TABLET [Sulfazine EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | None |
SULINDAC 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SULINDAC 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SULINDAC 200 MG TABLET [Clinoril] ![Compare how all Medicare Part D PDP plans in UT cover SULINDAC 200 MG TABLET [Clinoril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
SUMATRIPTAN 20 MG NASAL SPRAY [Imitrex] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 20 MG NASAL SPRAY [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | S Q:12 /30Days |
SUMATRIPTAN 4 MG/0.5 ML INJECT PEN [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 4 MG/0.5 ML INJECT PEN [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:4 /30Days |
SUMATRIPTAN 4 MG/0.5 ML PEN INJECTOR [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 4 MG/0.5 ML PEN INJECTOR [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Sumatriptan 5 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in UT cover Sumatriptan 5 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | S Q:12 /30Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:4 /30Days |
SUMATRIPTAN 6 MG/0.5 ML PEN INJCTR [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 6 MG/0.5 ML PEN INJCTR [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:4 /30Days |
SUMATRIPTAN 6 MG/0.5 ML VIAL [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN 6 MG/0.5 ML VIAL [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $20.00 | Q:4 /30Days |
SUMATRIPTAN SUCC 100 MG TABLET [Imitrex] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN SUCC 100 MG TABLET [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:9 /30Days |
SUMATRIPTAN SUCC 25 MG TABLET [Imitrex] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN SUCC 25 MG TABLET [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:9 /30Days |
SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack] ![Compare how all Medicare Part D PDP plans in UT cover SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:9 /30Days |
SUNITINIB MALATE 12.5 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in UT cover SUNITINIB MALATE 12.5 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:90 /30Days |
SUNITINIB MALATE 25 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in UT cover SUNITINIB MALATE 25 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
SUNITINIB MALATE 37.5 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in UT cover SUNITINIB MALATE 37.5 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
SUNITINIB MALATE 50 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in UT cover SUNITINIB MALATE 50 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUNOSI 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUNOSI 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
SUNOSI 75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SUNOSI 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
SUPRAX 100 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 100 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:60 /30Days |
SUPRAX 200 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 200 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:60 /30Days |
SUPRAX 200 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 200 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
SUPREP BOWEL PREP KIT SOLUTION RECON ![Compare how all Medicare Part D PDP plans in UT cover SUPREP BOWEL PREP KIT SOLUTION RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in UT cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:20 /30Days |
SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER ![Compare how all Medicare Part D PDP plans in UT cover SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:20 /30Days |
SYMDEKO 100/150 MG-150 MG TABS ![Compare how all Medicare Part D PDP plans in UT cover SYMDEKO 100/150 MG-150 MG TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SYMDEKO 50/75 MG-75 MG TABLET SEQ ![Compare how all Medicare Part D PDP plans in UT cover SYMDEKO 50/75 MG-75 MG TABLET SEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMJEPI 0.15 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover SYMJEPI 0.15 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
SYMJEPI 0.3 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover SYMJEPI 0.3 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:11 /30Days |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:11 /30Days |
SYMPAZAN 10 MG FILM ![Compare how all Medicare Part D PDP plans in UT cover SYMPAZAN 10 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SYMPAZAN 20 MG FILM ![Compare how all Medicare Part D PDP plans in UT cover SYMPAZAN 20 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SYMPAZAN 5 MG FILM ![Compare how all Medicare Part D PDP plans in UT cover SYMPAZAN 5 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P Q:60 /30Days |
SYMPROIC 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYMPROIC 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
SYMTUZA 800-150-200-10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYMTUZA 800-150-200-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in UT cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P |
SYNJARDY 12.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 12.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNJARDY 12.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 12.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNJARDY 5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY 5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNJARDY XR 10-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 10-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNJARDY XR 12.5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 12.5-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNJARDY XR 25-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 25-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNJARDY XR 5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in UT cover SYNJARDY XR 5-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
SYNTHROID 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
Synthroid 137ug/1 90 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in UT cover Synthroid 137ug/1 90 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYNTHROID 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in UT cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |