2023 Medicare Part D Plan Formulary Information |
Geisinger Gold Classic Complete Rx (HMO) (H3954-158-13)
Benefit Details
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic Complete Rx (HMO). 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 Geisinger Gold Classic Complete Rx (HMO) (H3954-158-13) Formulary Drugs Starting with the Letter A in Cameron County, PA: CMS MA Region 6 which includes: PA
|
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ABACAVIR 20 MG/ML SOLUTION [Ziagen] ![Compare how all Medicare Part D PDP plans in PA cover ABACAVIR 20 MG/ML SOLUTION [Ziagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:960 /30Days |
ABACAVIR 300 MG TABLET [Ziagen] ![Compare how all Medicare Part D PDP plans in PA cover ABACAVIR 300 MG TABLET [Ziagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days |
ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom] ![Compare how all Medicare Part D PDP plans in PA cover ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ABELCET INJECTION SUSPENSION 5MG/ML ![Compare how all Medicare Part D PDP plans in PA cover ABELCET INJECTION SUSPENSION 5MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ABILIFY ASIMTUFII 720 MG/2.4ML SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY ASIMTUFII 720 MG/2.4ML SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:2 /56Days |
ABILIFY ASIMTUFII 960 MG/3.2ML SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY ASIMTUFII 960 MG/3.2ML SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:3 /56Days |
ABILIFY MAINTENA ER 300 MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 300 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1 /28Days |
ABILIFY MAINTENA ER 300 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1 /28Days |
ABILIFY MAINTENA ER 400 MG SUSER VIAL ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 400 MG SUSER VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1 /28Days |
ABILIFY MAINTENA ER 400 MG SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MAINTENA ER 400 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABILIFY MYCITE 10 MG START KIT TABSENSTPD ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 10 MG START KIT TABSENSTPD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABILIFY MYCITE 15 MG MAINT KIT TABSENSSTR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 15 MG MAINT KIT TABSENSSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABILIFY MYCITE 2 MG MAINT KIT TABSENSSTR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 2 MG MAINT KIT TABSENSSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABILIFY MYCITE 20 MG MAINT KIT TABSENSSTR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 20 MG MAINT KIT TABSENSSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABILIFY MYCITE 30 MG MAINT KIT TABSENSSTR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 30 MG MAINT KIT TABSENSSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABILIFY MYCITE 5 MG MAINT KIT TABSENSSTR ![Compare how all Medicare Part D PDP plans in PA cover ABILIFY MYCITE 5 MG MAINT KIT TABSENSSTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ABIRATERONE 500 MG TABLET [ZYTIGA] ![Compare how all Medicare Part D PDP plans in PA cover ABIRATERONE 500 MG TABLET [ZYTIGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA] ![Compare how all Medicare Part D PDP plans in PA cover ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:120 /30Days |
Acamprosate Calcium DR 333 MG tablets [Campral] ![Compare how all Medicare Part D PDP plans in PA cover Acamprosate Calcium DR 333 MG tablets [Campral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACARBOSE 100 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in PA cover ACARBOSE 100 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:90 /30Days |
ACARBOSE 25 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in PA cover ACARBOSE 25 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACARBOSE 50 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in PA cover ACARBOSE 50 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:90 /30Days |
ACEBUTOLOL 200 MG CAPSULE [Sectral] ![Compare how all Medicare Part D PDP plans in PA cover ACEBUTOLOL 200 MG CAPSULE [Sectral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ACEBUTOLOL 400 MG CAPSULE [Sectral] ![Compare how all Medicare Part D PDP plans in PA cover ACEBUTOLOL 400 MG CAPSULE [Sectral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ACETAMINOP-CODEINE 120-12 MG/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOP-CODEINE 120-12 MG/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:2700 /30Days |
ACETAMINOPHEN-COD #2 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN-COD #2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:390 /30Days |
ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3] ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:360 /30Days |
ACETAMINOPHEN-COD #4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACETAMINOPHEN-COD #4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:180 /30Days |
ACETAZOLAMIDE 125 MG TABLET [Diamox] ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE 125 MG TABLET [Diamox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACETAZOLAMIDE 250 MG TABLET [Diamox] ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE 250 MG TABLET [Diamox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels] ![Compare how all Medicare Part D PDP plans in PA cover ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACETIC ACID 2% EAR SOLUTION [VoSoL] ![Compare how all Medicare Part D PDP plans in PA cover ACETIC ACID 2% EAR SOLUTION [VoSoL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETYLCYSTEINE 10% VIAL [Mucosil Acetylcysteine] ![Compare how all Medicare Part D PDP plans in PA cover ACETYLCYSTEINE 10% VIAL [Mucosil Acetylcysteine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine] ![Compare how all Medicare Part D PDP plans in PA cover ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ACITRETIN 10 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 10 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
ACITRETIN 17.5 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 17.5 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
ACITRETIN 25 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in PA cover ACITRETIN 25 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ACTEMRA 162 MG/0.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA 162 MG/0.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ACTEMRA ACTPEN 162 MG/0.9 ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in PA cover ACTEMRA ACTPEN 162 MG/0.9 ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /28Days |
ACTHIB VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in PA cover ACTHIB VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
ACTIMMUNE 100 MCG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACTIMMUNE 100 MCG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
ACYCLOVIR 200 MG CAPSULE [Zovirax] ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 200 MG CAPSULE [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension] ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACYCLOVIR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACYCLOVIR 5% CREAM (g) [Zovirax] ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 5% CREAM (g) [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:5 /30Days |
ACYCLOVIR 5% OINTMENT [Zovirax] ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 5% OINTMENT [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACYCLOVIR 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ACYCLOVIR SODIUM 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ACYCLOVIR SODIUM 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ADACEL TDAP SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ADACEL TDAP SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in PA cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
ADAPALENE 0.1% CREAM (G) [Differin] ![Compare how all Medicare Part D PDP plans in PA cover ADAPALENE 0.1% CREAM (G) [Differin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ADAPALENE 0.3% GEL [Differin Pump] ![Compare how all Medicare Part D PDP plans in PA cover ADAPALENE 0.3% GEL [Differin Pump].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ADAPALENE-BNZYL PEROX 0.1-2.5% GEL W/PUMP [Epiduo] ![Compare how all Medicare Part D PDP plans in PA cover ADAPALENE-BNZYL PEROX 0.1-2.5% GEL W/PUMP [Epiduo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ADBRY 150 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ADBRY 150 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:6 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera] ![Compare how all Medicare Part D PDP plans in PA cover ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ADEMPAS 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADEMPAS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ADEMPAS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL ![Compare how all Medicare Part D PDP plans in PA cover ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
AIMOVIG 140 MG/ML AUTOINJECTOR ![Compare how all Medicare Part D PDP plans in PA cover AIMOVIG 140 MG/ML AUTOINJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:1 /30Days |
AIMOVIG 70 MG/ML AUTOINJECTOR ![Compare how all Medicare Part D PDP plans in PA cover AIMOVIG 70 MG/ML AUTOINJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:1 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AJOVY 225 MG/1.5 ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in PA cover AJOVY 225 MG/1.5 ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:2 /30Days |
AJOVY 225 MG/1.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover AJOVY 225 MG/1.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:2 /30Days |
ALA-SCALP 2% LOTION [Scalacort] ![Compare how all Medicare Part D PDP plans in PA cover ALA-SCALP 2% LOTION [Scalacort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBENDAZOLE 200 MG TABLET [Albenza] ![Compare how all Medicare Part D PDP plans in PA cover ALBENDAZOLE 200 MG TABLET [Albenza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBUTEROL 2.5 MG/0.5 ML SOL VIAL-NEB ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL 2.5 MG/0.5 ML SOL VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb] ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB [Accuneb] ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB [Accuneb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ALBUTEROL SULF 2 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULF 2 MG/5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBUTEROL SULFATE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALBUTEROL SULFATE 2.5 MG/3 ML SOLUTION VIAL-NEB ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 2.5 MG/3 ML SOLUTION VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ALBUTEROL SULFATE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALBUTEROL SULFATE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate] ![Compare how all Medicare Part D PDP plans in PA cover ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALCLOMETASONE DIPRO 0.05% CREAM (G) [Aclovate] ![Compare how all Medicare Part D PDP plans in PA cover ALCLOMETASONE DIPRO 0.05% CREAM (G) [Aclovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALECENSA 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ALECENSA 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:240 /30Days |
ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax] ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALENDRONATE SODIUM 10 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 10 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days |
ALENDRONATE SODIUM 35 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 35 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:4 /28Days |
ALENDRONATE SODIUM 70 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in PA cover ALENDRONATE SODIUM 70 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:4 /28Days |
ALFUZOSIN HCL ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALFUZOSIN HCL ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALISKIREN 150 MG TABLET [Tekturna] ![Compare how all Medicare Part D PDP plans in PA cover ALISKIREN 150 MG TABLET [Tekturna].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ALISKIREN 300 MG TABLET [Tekturna] ![Compare how all Medicare Part D PDP plans in PA cover ALISKIREN 300 MG TABLET [Tekturna].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ALKINDI SPRINKLE 0.5 MG CAPSULE SPRINK ![Compare how all Medicare Part D PDP plans in PA cover ALKINDI SPRINKLE 0.5 MG CAPSULE SPRINK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ALKINDI SPRINKLE 1 MG CAPSULE SPRINK ![Compare how all Medicare Part D PDP plans in PA cover ALKINDI SPRINKLE 1 MG CAPSULE SPRINK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ALKINDI SPRINKLE 2 MG CAPSULE SPRINK ![Compare how all Medicare Part D PDP plans in PA cover ALKINDI SPRINKLE 2 MG CAPSULE SPRINK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ALKINDI SPRINKLE 5 MG CAPSULE SPRINK ![Compare how all Medicare Part D PDP plans in PA cover ALKINDI SPRINKLE 5 MG CAPSULE SPRINK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ALLOPURINOL 100 MG TABLET [Zyloprim] ![Compare how all Medicare Part D PDP plans in PA cover ALLOPURINOL 100 MG TABLET [Zyloprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ALLOPURINOL 300 MG TABLET [Zyloprim] ![Compare how all Medicare Part D PDP plans in PA cover ALLOPURINOL 300 MG TABLET [Zyloprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ALMOTRIPTAN MALATE 12.5 MG TABLET [Axert] ![Compare how all Medicare Part D PDP plans in PA cover ALMOTRIPTAN MALATE 12.5 MG TABLET [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:16 /28Days |
ALMOTRIPTAN MALATE 6.25 MG TABLET [Axert] ![Compare how all Medicare Part D PDP plans in PA cover ALMOTRIPTAN MALATE 6.25 MG TABLET [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:16 /28Days |
ALOMIDE 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover ALOMIDE 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALOSETRON HCL 0.5 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in PA cover ALOSETRON HCL 0.5 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days |
ALOSETRON HCL 1 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in PA cover ALOSETRON HCL 1 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days |
ALPHAGAN P 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover ALPHAGAN P 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ALPRAZOLAM 0.25 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 0.25 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM 0.5 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 0.5 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM 1 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 1 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM 2 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM 2 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:150 /30Days |
ALPRAZOLAM ER 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ER 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ALPRAZOLAM ER 1 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ER 1 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ALPRAZOLAM ER 2 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ER 2 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:150 /30Days |
ALPRAZOLAM ER 3 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ER 3 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALPRAZOLAM INTENSOL 1 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM INTENSOL 1 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | Q:300 /30Days |
ALPRAZOLAM ODT 0.25 MG TABLET RAPDIS [Niravam] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ODT 0.25 MG TABLET RAPDIS [Niravam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM ODT 0.5 MG TABLET RAPDIS [Niravam] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ODT 0.5 MG TABLET RAPDIS [Niravam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM ODT 1 MG TABLET RAPDIS [Niravam] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ODT 1 MG TABLET RAPDIS [Niravam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:120 /30Days |
ALPRAZOLAM ODT 2 MG TABLET RAPDIS [Niravam] ![Compare how all Medicare Part D PDP plans in PA cover ALPRAZOLAM ODT 2 MG TABLET RAPDIS [Niravam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:150 /30Days |
ALREX 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover ALREX 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
ALTAVERA-28 TABLET [Portia] ![Compare how all Medicare Part D PDP plans in PA cover ALTAVERA-28 TABLET [Portia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALUNBRIG 180 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALUNBRIG 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ALUNBRIG 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALUNBRIG 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
ALUNBRIG 90 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALUNBRIG 90 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
ALUNBRIG 90 MG-180 MG TABLET PACK ![Compare how all Medicare Part D PDP plans in PA cover ALUNBRIG 90 MG-180 MG TABLET PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /180Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALYACEN 1-35-28 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALYACEN 1-35-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ALYQ 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ALYQ 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
AMABELZ 0.5 MG-0.1 MG TABLET [Mimvey Lo] ![Compare how all Medicare Part D PDP plans in PA cover AMABELZ 0.5 MG-0.1 MG TABLET [Mimvey Lo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMABELZ 1 MG-0.5 MG TABLET [Mimvey] ![Compare how all Medicare Part D PDP plans in PA cover AMABELZ 1 MG-0.5 MG TABLET [Mimvey].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMANTADINE 100 MG CAPSULE [Symmetrel] ![Compare how all Medicare Part D PDP plans in PA cover AMANTADINE 100 MG CAPSULE [Symmetrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMANTADINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMANTADINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMANTADINE 50 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover AMANTADINE 50 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMBISOME 50MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMBISOME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
AMBRISENTAN 10 MG TABLET [LETAIRIS] ![Compare how all Medicare Part D PDP plans in PA cover AMBRISENTAN 10 MG TABLET [LETAIRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AMBRISENTAN 5 MG TABLET [LETAIRIS] ![Compare how all Medicare Part D PDP plans in PA cover AMBRISENTAN 5 MG TABLET [LETAIRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AMCINONIDE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in PA cover AMCINONIDE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMCINONIDE 0.1% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover AMCINONIDE 0.1% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMETHIA 0.15-0.03-0.01 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMETHIA 0.15-0.03-0.01 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMIKACIN SULF 500 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMIKACIN SULF 500 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMILORIDE HCL 5 MG TABLET [Midamor] ![Compare how all Medicare Part D PDP plans in PA cover AMILORIDE HCL 5 MG TABLET [Midamor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic] ![Compare how all Medicare Part D PDP plans in PA cover AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMIODARONE HCL 100 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 100 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMIODARONE HCL 200 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 200 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMIODARONE HCL 400 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in PA cover AMIODARONE HCL 400 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMITRIP/CDP 25-10 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/CDP 25-10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIP/PERPHEN 10-4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 10-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
AMITRIP/PERPHEN 50-4 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIP/PERPHEN 50-4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMITRIPTYLINE HCL 10 MG TABLET [Elavil] ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 10 MG TABLET [Elavil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIPTYLINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIPTYLINE HCL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIPTYLINE HCL 25 MG TABLET [Elavil] ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 25 MG TABLET [Elavil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIPTYLINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMITRIPTYLINE HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMITRIPTYLINE HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMLOD-VALSA-HCTZ 10-160-12.5MG TABLET [Exforge HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-160-12.5MG TABLET [Exforge HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLOD-VALSA-HCTZ 10-160-25 MG TABLET [Exforge HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-160-25 MG TABLET [Exforge HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLOD-VALSA-HCTZ 10-320-25 MG TABLET [Exforge HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 10-320-25 MG TABLET [Exforge HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLOD-VALSA-HCTZ 5-160-12.5 MG TABLET [Exforge HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 5-160-12.5 MG TABLET [Exforge HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLOD-VALSA-HCTZ 5-160-25 MG TABLET [Exforge HCT] ![Compare how all Medicare Part D PDP plans in PA cover AMLOD-VALSA-HCTZ 5-160-25 MG TABLET [Exforge HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE 10 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 10 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE BESYLATE 5 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE BESYLATE 5 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-ATORVAST 10-10 MG [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-ATORVAST 10-10 MG [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-ATORVAST 10-20 MG [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-ATORVAST 10-20 MG [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-ATORVAST 10-40 MG [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-ATORVAST 10-40 MG [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 10-80 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 10-80 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 2.5-10 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-10 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 2.5-20 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-20 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 2.5-40 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 2.5-40 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-10 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-10 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Amlodipine-Atorvastatin 5-20 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-20 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-40 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-40 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Amlodipine-Atorvastatin 5-80 mg [Caduet] ![Compare how all Medicare Part D PDP plans in PA cover Amlodipine-Atorvastatin 5-80 mg [Caduet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in PA cover AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin] ![Compare how all Medicare Part D PDP plans in PA cover AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in PA cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMNESTEEM 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in PA cover AMNESTEEM 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMNESTEEM 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in PA cover AMNESTEEM 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMNESTEEM 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in PA cover AMNESTEEM 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 200-28.5 MG/5 ML SUS ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 200-28.5 MG/5 ML SUS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 250-62.5 MG/5 ML ORAL SUSPENSION [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 250-62.5 MG/5 ML ORAL SUSPENSION [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 500-125 MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 500-125 MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 600-42.9 MG/5 ML SUS ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 600-42.9 MG/5 ML SUS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV 875-125 MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV 875-125 MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in PA cover AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMOXICILLIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 125MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 125MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil] ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 250 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 250 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 250 MG CAPSULE [Trimox] ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 250 MG CAPSULE [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox] ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil] ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 500 MG CAPSULE [Trimox] ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 500 MG CAPSULE [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOXICILLIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMOXICILLIN 875 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMOXICILLIN 875 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALT COMBO 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPHETAMINE SALTS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AMPHETAMINE SALTS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPHOTERICIN B 50 MG VIAL [Fungizone] ![Compare how all Medicare Part D PDP plans in PA cover AMPHOTERICIN B 50 MG VIAL [Fungizone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AMPICILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPICILLIN 10 GM BOTTLE VIAL ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN 10 GM BOTTLE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPICILLIN 1000 MG / Sulbactam 500 MG Injection ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN 1000 MG / Sulbactam 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPICILLIN 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN CAPSULES 500MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN CAPSULES 500MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPICILLIN-SULBACTAM 15 GM VIAL [Unasyn] ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN-SULBACTAM 15 GM VIAL [Unasyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AMPICILLIN-SULBACTAM 3 GM VIAL [Unasyn] ![Compare how all Medicare Part D PDP plans in PA cover AMPICILLIN-SULBACTAM 3 GM VIAL [Unasyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ANAGRELIDE HCL 0.5 MG CAPSULE [Agrylin] ![Compare how all Medicare Part D PDP plans in PA cover ANAGRELIDE HCL 0.5 MG CAPSULE [Agrylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ANAGRELIDE HCL 1 MG CAPSULE [Agrylin] ![Compare how all Medicare Part D PDP plans in PA cover ANAGRELIDE HCL 1 MG CAPSULE [Agrylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ANASTROZOLE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ANASTROZOLE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ANORO ELLIPTA 62.5-25 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover ANORO ELLIPTA 62.5-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | Q:60 /30Days |
APLENZIN ER 174 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 174 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:30 /30Days |
APLENZIN ER 348 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 348 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:30 /30Days |
APLENZIN ER 522 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APLENZIN ER 522 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:30 /30Days |
APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn] ![Compare how all Medicare Part D PDP plans in PA cover APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
APRACLONIDINE HCL 0.5% DROPS [Iopidine] ![Compare how all Medicare Part D PDP plans in PA cover APRACLONIDINE HCL 0.5% DROPS [Iopidine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
APREPITANT 125 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in PA cover APREPITANT 125 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
APREPITANT 125-80-80 MG PACK CAPSULE DS PK [Emend] ![Compare how all Medicare Part D PDP plans in PA cover APREPITANT 125-80-80 MG PACK CAPSULE DS PK [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
APREPITANT 40 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in PA cover APREPITANT 40 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
APREPITANT 80 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in PA cover APREPITANT 80 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PA cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
APTIOM 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:30 /30Days |
APTIOM 400 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:30 /30Days |
APTIOM 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
APTIOM 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover APTIOM 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARALAST NP 1,000 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARALAST NP 1,000 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ARANESP 10 MCG/0.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 10 MCG/0.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 200MCG/0.4ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 200MCG/0.4ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 200MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 200MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 500MCG/1ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 500MCG/1ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP 60MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 60MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR ![Compare how all Medicare Part D PDP plans in PA cover ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARAZLO 0.045% LOTION ![Compare how all Medicare Part D PDP plans in PA cover ARAZLO 0.045% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ARCALYST 220 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover ARCALYST 220 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
ARFORMOTEROL 15 MCG/2 ML SOLUTION VIAL-NEB [Brovana] ![Compare how all Medicare Part D PDP plans in PA cover ARFORMOTEROL 15 MCG/2 ML SOLUTION VIAL-NEB [Brovana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ARIPIPRAZOLE 10 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 10 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 15 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 15 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARIPIPRAZOLE 2 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 2 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 20 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 20 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 30 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 30 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 5 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE 5 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:60 /30Days |
ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt] ![Compare how all Medicare Part D PDP plans in PA cover ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:60 /30Days |
ARISTADA ER 1064 MG/3.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 1064 MG/3.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:4 /56Days |
ARISTADA ER 441 MG/1.6 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 441 MG/1.6 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:2 /28Days |
ARISTADA ER 662 MG/2.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 662 MG/2.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:2 /28Days |
ARISTADA ER 882 MG/3.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA ER 882 MG/3.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:2 /180Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARMODAFINIL 150 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in PA cover ARMODAFINIL 150 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ARMODAFINIL 200 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in PA cover ARMODAFINIL 200 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ARMODAFINIL 250 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in PA cover ARMODAFINIL 250 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ARMODAFINIL 50 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in PA cover ARMODAFINIL 50 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ARNUITY ELLIPTA 100 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover ARNUITY ELLIPTA 100 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ARNUITY ELLIPTA 200 MCG INH ![Compare how all Medicare Part D PDP plans in PA cover ARNUITY ELLIPTA 200 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ARNUITY ELLIPTA 50 MCG INH BLST W/DEV ![Compare how all Medicare Part D PDP plans in PA cover ARNUITY ELLIPTA 50 MCG INH BLST W/DEV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris] ![Compare how all Medicare Part D PDP plans in PA cover ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris] ![Compare how all Medicare Part D PDP plans in PA cover ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris] ![Compare how all Medicare Part D PDP plans in PA cover ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P Q:60 /30Days |
ASHLYNA 0.15-0.03-0.01 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ASHLYNA 0.15-0.03-0.01 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ASMANEX HFA 100 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX HFA 100 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX HFA 200 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX HFA 200 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX HFA 50 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX HFA 50 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX TWISTHALER 110 MCG #30 AER POW BA ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX TWISTHALER 110 MCG #30 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX TWISTHALER 220 MCG #120 AER POW BA ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX TWISTHALER 220 MCG #120 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX TWISTHALER 220 MCG #30 AER POW BA ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX TWISTHALER 220 MCG #30 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASMANEX TWISTHALER 220 MCG #60 AER POW BA ![Compare how all Medicare Part D PDP plans in PA cover ASMANEX TWISTHALER 220 MCG #60 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | S |
ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox] ![Compare how all Medicare Part D PDP plans in PA cover ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ASTAGRAF XL 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ASTAGRAF XL 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
ASTAGRAF XL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover ASTAGRAF XL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in PA cover ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days |
ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in PA cover ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days |
ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in PA cover ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | Q:30 /30Days |
ATENOLOL 100 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL 100 MG TABLET [Tenormin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ATENOLOL 25 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL 25 MG TABLET [Tenormin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ATENOLOL 50 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL 50 MG TABLET [Tenormin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ATENOLOL-CHLORTHALIDONE 100-25 TABLET [Tenoretic] ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL-CHLORTHALIDONE 100-25 TABLET [Tenoretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ATENOLOL-CHLORTHALIDONE 50-25 TABLET [Tenoretic] ![Compare how all Medicare Part D PDP plans in PA cover ATENOLOL-CHLORTHALIDONE 50-25 TABLET [Tenoretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | None |
ATOMOXETINE HCL 10 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 10 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATOMOXETINE HCL 100 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 100 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATOMOXETINE HCL 18 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 18 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATOMOXETINE HCL 25 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 25 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATOMOXETINE HCL 40 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 40 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATOMOXETINE HCL 60 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 60 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATOMOXETINE HCL 80 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in PA cover ATOMOXETINE HCL 80 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
ATORVASTATIN 10 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 10 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:45 /30Days |
ATORVASTATIN 20 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 20 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:45 /30Days |
ATORVASTATIN 40 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 40 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:45 /30Days |
ATORVASTATIN 80 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in PA cover ATORVASTATIN 80 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $0.00 | Q:30 /30Days |
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron] ![Compare how all Medicare Part D PDP plans in PA cover ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone] ![Compare how all Medicare Part D PDP plans in PA cover Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ATOVAQUONE-PROGUANIL 62.5-25 [Malarone] ![Compare how all Medicare Part D PDP plans in PA cover ATOVAQUONE-PROGUANIL 62.5-25 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ATROPINE 1% EYE DROPS [Isopto Atropine] ![Compare how all Medicare Part D PDP plans in PA cover ATROPINE 1% EYE DROPS [Isopto Atropine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in PA cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $70.50 | None |
AUBRA EQ-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in PA cover AUBRA EQ-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AURYXIA 210 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AURYXIA 210 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:360 /30Days |
AUSTEDO 12 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AUSTEDO 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
AUSTEDO 6 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AUSTEDO 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
AUSTEDO 9 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AUSTEDO 9 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
AUVELITY ER 45-105 MG TABLET IR ER ![Compare how all Medicare Part D PDP plans in PA cover AUVELITY ER 45-105 MG TABLET IR ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P Q:60 /30Days |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in PA cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AVONEX PEN 30 MCG/0.5 ML KIT ![Compare how all Medicare Part D PDP plans in PA cover AVONEX PEN 30 MCG/0.5 ML KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
AVONEX PREFILLED SYR 30 MCG KT ![Compare how all Medicare Part D PDP plans in PA cover AVONEX PREFILLED SYR 30 MCG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AYVAKIT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AYVAKIT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AYVAKIT 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AYVAKIT 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AYVAKIT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AYVAKIT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AYVAKIT 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AYVAKIT 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AYVAKIT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AYVAKIT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
AZASAN 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZASAN 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
AZASAN 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover AZASAN 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | P |
AZASITE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover AZASITE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
AZATHIOPRINE 100 MG TABLET [Azasan] ![Compare how all Medicare Part D PDP plans in PA cover AZATHIOPRINE 100 MG TABLET [Azasan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AZATHIOPRINE 50 MG TABLET [Imuran] ![Compare how all Medicare Part D PDP plans in PA cover AZATHIOPRINE 50 MG TABLET [Imuran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
AZATHIOPRINE 75 MG TABLET [Azasan] ![Compare how all Medicare Part D PDP plans in PA cover AZATHIOPRINE 75 MG TABLET [Azasan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZELAIC ACID 15% GEL [Finacea] ![Compare how all Medicare Part D PDP plans in PA cover AZELAIC ACID 15% GEL [Finacea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZELASTIN-FLUTIC 137-50MCG SPRAY/PUMP [Dymista] ![Compare how all Medicare Part D PDP plans in PA cover AZELASTIN-FLUTIC 137-50MCG SPRAY/PUMP [Dymista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZELASTINE 137 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover AZELASTINE 137 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZELASTINE HCL 0.05% EYE DROPS [Optivar] ![Compare how all Medicare Part D PDP plans in PA cover AZELASTINE HCL 0.05% EYE DROPS [Optivar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 1 GM POWDER PACKET ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 1 GM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax Powder] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZITHROMYCIN I.V. 500 MG VIAL [Zithromax Powder] ![Compare how all Medicare Part D PDP plans in PA cover AZITHROMYCIN I.V. 500 MG VIAL [Zithromax Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | $0.00 | None |
AZTREONAM 2 GM VIAL [Azactam] ![Compare how all Medicare Part D PDP plans in PA cover AZTREONAM 2 GM VIAL [Azactam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |
AZTREONAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover AZTREONAM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $150.00 | None |