2023 Medicare Part D Plan Formulary Information |
Cigna Saver Rx (PDP) (S5617-381-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Cigna Saver Rx (PDP). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. Call drug plan for more details. |
The Cigna Saver Rx (PDP) (S5617-381-0) Formulary Drugs Starting with the Letter P in CMS PDP Region 31 which includes: ID UT
|
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 |
PACERONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PACERONE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PACERONE 400 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PACERONE 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PALIPERIDONE ER 1.5 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in UT cover PALIPERIDONE ER 1.5 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
PALIPERIDONE ER 3 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in UT cover PALIPERIDONE ER 3 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
PALIPERIDONE ER 6 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in UT cover PALIPERIDONE ER 6 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
PALIPERIDONE ER 9 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in UT cover PALIPERIDONE ER 9 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
PANRETIN 0.1% GEL ![Compare how all Medicare Part D PDP plans in UT cover PANRETIN 0.1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
PANTOPRAZOLE SOD DR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PANTOPRAZOLE SOD DR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
PANTOPRAZOLE SOD DR 40 MG TABLET DR [Protonix] ![Compare how all Medicare Part D PDP plans in UT cover PANTOPRAZOLE SOD DR 40 MG TABLET DR [Protonix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PARICALCITOL 1 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in UT cover PARICALCITOL 1 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PARICALCITOL 2 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in UT cover PARICALCITOL 2 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PARICALCITOL 4 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in UT cover PARICALCITOL 4 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PAROMOMYCIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PAROMOMYCIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PAROXETINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:180 /30Days |
PAROXETINE HCL 10 MG/5 ML ORAL SUSPENSION [Paxil] ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL 10 MG/5 ML ORAL SUSPENSION [Paxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S Q:900 /30Days |
PAROXETINE HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PAROXETINE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
PAROXETINE HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PAROXETINE HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PEDVAXHIB VACCINE VIAL ![Compare how all Medicare Part D PDP plans in UT cover PEDVAXHIB VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte] ![Compare how all Medicare Part D PDP plans in UT cover PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PEG-3350 AND ELECTROLYTES SOLUTION SOLUTION RECON ![Compare how all Medicare Part D PDP plans in UT cover PEG-3350 AND ELECTROLYTES SOLUTION SOLUTION RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PEGASYS 180 MCG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover PEGASYS 180 MCG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
PEGASYS 180 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PEGASYS 180 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
PEMAZYRE 13.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PEMAZYRE 13.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:14 /21Days |
PEMAZYRE 4.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PEMAZYRE 4.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:14 /21Days |
PEMAZYRE 9 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PEMAZYRE 9 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:14 /21Days |
PENICILLAMINE 250 MG CAPSULE [Cuprimine] ![Compare how all Medicare Part D PDP plans in UT cover PENICILLAMINE 250 MG CAPSULE [Cuprimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
PENICILLAMINE 250 MG TABLET [Depen] ![Compare how all Medicare Part D PDP plans in UT cover PENICILLAMINE 250 MG TABLET [Depen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
PENICILLIN GK 20 MILLION UNIT ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN GK 20 MILLION UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN V POTASSIUM 250MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PENICILLIN VK 125 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN VK 125 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENICILLIN VK 250 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN VK 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PENICILLIN VK 500 MG TABLET [Veetids] ![Compare how all Medicare Part D PDP plans in UT cover PENICILLIN VK 500 MG TABLET [Veetids].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PENNSAID 2% PUMP ![Compare how all Medicare Part D PDP plans in UT cover PENNSAID 2% PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:224 /28Days |
PENTACEL VIAL KIT ![Compare how all Medicare Part D PDP plans in UT cover PENTACEL VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent] ![Compare how all Medicare Part D PDP plans in UT cover PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:1 /28Days |
PENTAMIDINE 300 MG VIAL [Pentam] ![Compare how all Medicare Part D PDP plans in UT cover PENTAMIDINE 300 MG VIAL [Pentam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTASA 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in UT cover PENTASA 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTASA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PENTASA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTOXIFYLLINE 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in UT cover PENTOXIFYLLINE 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PERINDOPRIL ERBUMINE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERINDOPRIL ERBUMINE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PERINDOPRIL ERBUMINE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERINDOPRIL ERBUMINE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERINDOPRIL ERBUMINE 8 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERINDOPRIL ERBUMINE 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PERIOGARD 0.12% ORAL RINSE MOUTHWASH [Perisol] ![Compare how all Medicare Part D PDP plans in UT cover PERIOGARD 0.12% ORAL RINSE MOUTHWASH [Perisol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PERMETHRIN 5% CREAM (G) [Elimite] ![Compare how all Medicare Part D PDP plans in UT cover PERMETHRIN 5% CREAM (G) [Elimite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PERPHEN-AMITRIP 2 MG-10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERPHEN-AMITRIP 2 MG-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHEN-AMITRIP 2 MG-25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERPHEN-AMITRIP 2 MG-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHEN-AMITRIP 4 MG-25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PERPHEN-AMITRIP 4 MG-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHENAZINE 16 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE 16 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PERPHENAZINE 2 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE 2 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PERPHENAZINE 4 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE 4 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHENAZINE 8 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in UT cover PERPHENAZINE 8 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT ![Compare how all Medicare Part D PDP plans in UT cover PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT ![Compare how all Medicare Part D PDP plans in UT cover PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /28Days |
PHENELZINE SULFATE 15 MG TABLET [Nardil] ![Compare how all Medicare Part D PDP plans in UT cover PHENELZINE SULFATE 15 MG TABLET [Nardil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Phenobarbital 100mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 16.2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 16.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 20 MG/5 ML ELIXIR ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 20 MG/5 ML ELIXIR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1500 /30Days |
PHENOBARBITAL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 32.4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 32.4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
Phenobarbital 60mg/1 ![Compare how all Medicare Part D PDP plans in UT cover Phenobarbital 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 64.8 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 64.8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
PHENOBARBITAL 97.2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PHENOBARBITAL 97.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin] ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin] ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PHENYTOIN SOD EXT 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SOD EXT 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PHENYTOIN SOD EXT 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SOD EXT 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek] ![Compare how all Medicare Part D PDP plans in UT cover PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PHOSPHOLINE IODIDE 0.125% DROPS ![Compare how all Medicare Part D PDP plans in UT cover PHOSPHOLINE IODIDE 0.125% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIFELTRO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIFELTRO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PILOCARPINE 1% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE 1% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PILOCARPINE 2% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE 2% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PILOCARPINE 4% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE 4% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PILOCARPINE HCL 5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE HCL 5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PILOCARPINE HCL 7.5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in UT cover PILOCARPINE HCL 7.5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMOZIDE 1 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in UT cover PIMOZIDE 1 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMOZIDE 2 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in UT cover PIMOZIDE 2 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMTREA 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIMTREA 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PINDOLOL 10 MG TABLET [Visken] ![Compare how all Medicare Part D PDP plans in UT cover PINDOLOL 10 MG TABLET [Visken].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PINDOLOL 5 MG TABLET [Visken] ![Compare how all Medicare Part D PDP plans in UT cover PINDOLOL 5 MG TABLET [Visken].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PIOGLITAZONE HCL 15 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in UT cover PIOGLITAZONE HCL 15 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PIOGLITAZONE HCL 30 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in UT cover PIOGLITAZONE HCL 30 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | Q:30 /30Days |
PIOGLITAZONE HCL 45 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in UT cover PIOGLITAZONE HCL 45 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | Q:30 /30Days |
PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn Powder] ![Compare how all Medicare Part D PDP plans in UT cover PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in UT cover PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIPERACIL-TAZOBACT 4.5 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in UT cover PIPERACIL-TAZOBACT 4.5 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn Powder] ![Compare how all Medicare Part D PDP plans in UT cover PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIQRAY 200 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIQRAY 200 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
PIQRAY 250 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIQRAY 250 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
PIQRAY 300 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIQRAY 300 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
PIRFENIDONE 267 MG CAPSULE [ESBRIET] ![Compare how all Medicare Part D PDP plans in UT cover PIRFENIDONE 267 MG CAPSULE [ESBRIET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
PIRFENIDONE 267 MG TABLET [ESBRIET] ![Compare how all Medicare Part D PDP plans in UT cover PIRFENIDONE 267 MG TABLET [ESBRIET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
PIRFENIDONE 534 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PIRFENIDONE 534 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
PIRFENIDONE 801 MG TABLET [ESBRIET] ![Compare how all Medicare Part D PDP plans in UT cover PIRFENIDONE 801 MG TABLET [ESBRIET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
PLENAMINE 15% SOLUTION IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PLENAMINE 15% SOLUTION IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PODOFILOX 0.5% TOPICAL SOLUTION [Condylox] ![Compare how all Medicare Part D PDP plans in UT cover PODOFILOX 0.5% TOPICAL SOLUTION [Condylox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POLYCIN EYE OINTMENT [Polytracin] ![Compare how all Medicare Part D PDP plans in UT cover POLYCIN EYE OINTMENT [Polytracin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POLYMYXIN B-TMP EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover POLYMYXIN B-TMP EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POMALYST 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover POMALYST 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
PORTIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in UT cover PORTIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
POSACONAZOLE DR 100 MG TABLET [Noxafil] ![Compare how all Medicare Part D PDP plans in UT cover POSACONAZOLE DR 100 MG TABLET [Noxafil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:96 /30Days |
POTASSIUM CITRATE ER 10 MEQ TB ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CITRATE ER 10 MEQ TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 15 MEQ TABLET [Urocit-K] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CITRATE ER 15 MEQ TABLET [Urocit-K].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 5 MEQ TABLET ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CITRATE ER 5 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 10% (20 MEQ/15ML) LIQUID [Kay Ciel] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 10% (20 MEQ/15ML) LIQUID [Kay Ciel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ PACKET [Klor-Con] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 20 MEQ PACKET [Klor-Con].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
POTASSIUM CL 20 MEQ-0.45% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 20 MEQ-0.45% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ/1,000ML-NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 20 MEQ/1,000ML-NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20% (40 MEQ/15ML) LIQUID [Kaon-CL] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 20% (40 MEQ/15ML) LIQUID [Kaon-CL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 40 MEQ/1,000ML-NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 40 MEQ/1,000ML-NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 40 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 40 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 60 MEQ/30 ML CONC VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL 60 MEQ/30 ML CONC VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL ER 10 MEQ CAPSULE ER [Micro-K Extencaps] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 10 MEQ CAPSULE ER [Micro-K Extencaps].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
POTASSIUM CL ER 10 MEQ TABLET [Klotrix] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 10 MEQ TABLET [Klotrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POTASSIUM CL ER 10 MEQ TABLET PRT [Klotrix] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 10 MEQ TABLET PRT [Klotrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POTASSIUM CL ER 15 MEQ TABLET ER PRT [Klor-Con M15] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 15 MEQ TABLET ER PRT [Klor-Con M15].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POTASSIUM CL ER 20 MEQ TABLET [K-Tab] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 20 MEQ TABLET [K-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POTASSIUM CL ER 20 MEQ TABLET PRT [Klor-Con M20] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 20 MEQ TABLET PRT [Klor-Con M20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
POTASSIUM CL ER 8 MEQ TABLET [Slow-K] ![Compare how all Medicare Part D PDP plans in UT cover POTASSIUM CL ER 8 MEQ TABLET [Slow-K].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PRADAXA 110 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PRADAXA 110 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | S |
PRALUENT 150 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover PRALUENT 150 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:2 /28Days |
PRALUENT 75 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in UT cover PRALUENT 75 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAMIPEXOLE 0.125 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 0.125 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAMIPEXOLE 0.25 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 0.25 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAMIPEXOLE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAMIPEXOLE 0.75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 0.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAMIPEXOLE 1 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 1 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAMIPEXOLE 1.5 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in UT cover PRAMIPEXOLE 1.5 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRASUGREL 10 MG TABLET [Effient] ![Compare how all Medicare Part D PDP plans in UT cover PRASUGREL 10 MG TABLET [Effient].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRASUGREL 5 MG TABLET [Effient] ![Compare how all Medicare Part D PDP plans in UT cover PRASUGREL 5 MG TABLET [Effient].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAVASTATIN SODIUM 10 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 10 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PRAVASTATIN SODIUM 20 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PRAVASTATIN SODIUM 40 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 40 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAVASTATIN SODIUM 80 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in UT cover PRAVASTATIN SODIUM 80 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
PRAZIQUANTEL 600 MG TABLET [Biltricide] ![Compare how all Medicare Part D PDP plans in UT cover PRAZIQUANTEL 600 MG TABLET [Biltricide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRAZOSIN 1 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN 1 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAZOSIN 2 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN 2 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRAZOSIN 5 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in UT cover PRAZOSIN 5 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREDNISOLONE 15 MG/5 ML SOLUTION [Prelone] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE 15 MG/5 ML SOLUTION [Prelone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREDNISOLONE 5 MG/5 ML SOLUTION [Pediapred] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE 5 MG/5 ML SOLUTION [Pediapred].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREDNISOLONE AC 1% EYE DROPPER [Pred-Forte] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE AC 1% EYE DROPPER [Pred-Forte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREDNISOLONE SOD 1% EYE DROP ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE SOD 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREDNISOLONE SOD PH 25 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISOLONE SOD PH 25 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREDNISONE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 1 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 |
PREDNISONE 10 MG TABLET [Sterapred DS] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 10 MG TABLET [Sterapred DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 10 MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 10 MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PREDNISONE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PREDNISONE 20 MG TABLET [Predone] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 20 MG TABLET [Predone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PREDNISONE 5 MG TABLET [Sterapred] ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5 MG TABLET [Sterapred].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PREDNISONE 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREDNISONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
PREDNISONE 5MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREDNISONE 5MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREGABALIN 100 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 100 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
PREGABALIN 150 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 150 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
PREGABALIN 20 MG/ML SOLUTION [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 20 MG/ML SOLUTION [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:900 /30Days |
PREGABALIN 200 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 200 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days |
PREGABALIN 225 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 225 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
PREGABALIN 25 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 25 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
PREGABALIN 300 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 300 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
PREGABALIN 50 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 50 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
PREGABALIN 75 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in UT cover PREGABALIN 75 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days |
PREHEVBRIO 10 MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PREHEVBRIO 10 MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
PREMARIN 0.3 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMARIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREMARIN 0.625 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.625 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Premarin 0.625mg/g ![Compare how all Medicare Part D PDP plans in UT cover Premarin 0.625mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREMARIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREMARIN 1.25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREMARIN 1.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREMASOL 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover PREMASOL 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PREVALITE PACKET ![Compare how all Medicare Part D PDP plans in UT cover PREVALITE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PREVYMIS 240 MG ![Compare how all Medicare Part D PDP plans in UT cover PREVYMIS 240 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
PREVYMIS 480 MG ![Compare how all Medicare Part D PDP plans in UT cover PREVYMIS 480 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
PREZCOBIX 800 MG-150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREZCOBIX 800 MG-150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
PREZISTA 100 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA 100 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:400 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREZISTA 150MG TABLETS ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA 150MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:240 /30Days |
PREZISTA 800 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
PREZISTA TABLET 600MG ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLET 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
PREZISTA TABLET 75MG ![Compare how all Medicare Part D PDP plans in UT cover PREZISTA TABLET 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:480 /30Days |
PRIFTIN 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRIFTIN 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRIMAQUINE 26.3 MG TABLET [Primaquine] ![Compare how all Medicare Part D PDP plans in UT cover PRIMAQUINE 26.3 MG TABLET [Primaquine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRIMIDONE 125 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PRIMIDONE 125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRIMIDONE 250 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in UT cover PRIMIDONE 250 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PRIMIDONE 50 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in UT cover PRIMIDONE 50 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PRIORIX VIAL ![Compare how all Medicare Part D PDP plans in UT cover PRIORIX VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PRIVIGEN 10% VIAL ![Compare how all Medicare Part D PDP plans in UT cover PRIVIGEN 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROBENECID 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROBENECID 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROBENECID-COLCHICINE TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROBENECID-COLCHICINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROCHLORPERAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROCHLORPERAZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in UT cover PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROCRIT 10000U/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 10000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 2000U/ML VIAL 6 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 3,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 3,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 4,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 4,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 40000U/ML VIAL PR ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT 40000U/ML VIAL PR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY ![Compare how all Medicare Part D PDP plans in UT cover PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCTO-MED HC 2.5% CREAM /PE APP [Proctozone-HC] ![Compare how all Medicare Part D PDP plans in UT cover PROCTO-MED HC 2.5% CREAM /PE APP [Proctozone-HC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROCTOSOL-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover PROCTOSOL-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROCTOZONE-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in UT cover PROCTOZONE-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROGESTERONE 100 MG CAPSULE [Prometrium] ![Compare how all Medicare Part D PDP plans in UT cover PROGESTERONE 100 MG CAPSULE [Prometrium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROGESTERONE 200 MG CAPSULE [Prometrium] ![Compare how all Medicare Part D PDP plans in UT cover PROGESTERONE 200 MG CAPSULE [Prometrium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROGRAF 0.2 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in UT cover PROGRAF 0.2 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROGRAF 1 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in UT cover PROGRAF 1 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROLASTIN C 1,000 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROLASTIN C 1,000 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
PROLIA 60MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in UT cover PROLIA 60MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /180Days |
PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:360 /30Days |
PROMACTA 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMACTA 25 MG SUSPENSION POWDER PACK ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 25 MG SUSPENSION POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
PROMACTA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PROMACTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PROMACTA 75 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMACTA 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
PROMETHAZINE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMETHAZINE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | P |
PROMETHAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMETHAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | P |
PROMETHAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROMETHAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | P |
PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain] ![Compare how all Medicare Part D PDP plans in UT cover PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROPAFENONE HCL 150 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL 150 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROPAFENONE HCL 225 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL 225 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROPAFENONE HCL 300 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL 300 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPAFENONE HCL ER 225 MG CAPSULE 12H [Rythmol SR] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL ER 225 MG CAPSULE 12H [Rythmol SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPAFENONE HCL ER 325 MG CAPSULE 12H [Rythmol SR] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL ER 325 MG CAPSULE 12H [Rythmol SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPAFENONE HCL ER 425 MG CAPSULE 12H [Rythmol SR] ![Compare how all Medicare Part D PDP plans in UT cover PROPAFENONE HCL ER 425 MG CAPSULE 12H [Rythmol SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPRANOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROPRANOLOL 20 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 20 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROPRANOLOL 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROPRANOLOL 40 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 40 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROPRANOLOL 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROPRANOLOL 60 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROPRANOLOL 80 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL 80 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $6.00 | None |
PROPRANOLOL ER 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL ER 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL ER 160 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL ER 160 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPRANOLOL ER 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL ER 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPRANOLOL ER 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover PROPRANOLOL ER 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPYLTHIOURACIL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PROPYLTHIOURACIL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROQUAD VIAL ![Compare how all Medicare Part D PDP plans in UT cover PROQUAD VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PROSOL 20% INJECTION ![Compare how all Medicare Part D PDP plans in UT cover PROSOL 20% INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROTRIPTYLINE HCL 10 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in UT cover PROTRIPTYLINE HCL 10 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROTRIPTYLINE HCL 5 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in UT cover PROTRIPTYLINE HCL 5 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PULMOZYME 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in UT cover PULMOZYME 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:150 /30Days |
PURIXAN 20 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover PURIXAN 20 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
PYRAZINAMIDE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PYRAZINAMIDE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PYRIDOSTIGMINE BR 60 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PYRIDOSTIGMINE BR 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
PYRIDOSTIGMINE BR ER 180 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover PYRIDOSTIGMINE BR ER 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PYRIMETHAMINE 25 MG TABLET [Daraprim] ![Compare how all Medicare Part D PDP plans in UT cover PYRIMETHAMINE 25 MG TABLET [Daraprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |