2023 Medicare Part D Plan Formulary Information |
Mutual of Omaha Rx Premier (PDP) (S7126-079-0)
Benefit Details
 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 Mutual of Omaha Rx Premier (PDP) (S7126-079-0) Formulary Drugs Starting with the Letter C in CMS PDP Region 10 which includes: GA
|
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET [Dostinex] ![Compare how all Medicare Part D PDP plans in GA cover CABERGOLINE 0.5 MG TABLET [Dostinex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CABLIVI 11 MG KIT  |
5 |
Specialty Tier |
25% | N/A | P |
CABOMETYX 20 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
CABOMETYX 40 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
CABOMETYX 60 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
CALCIPOTRIENE 0.005% CREAM (G) [Dovonex] ![Compare how all Medicare Part D PDP plans in GA cover CALCIPOTRIENE 0.005% CREAM (G) [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /30Days |
CALCIPOTRIENE 0.005% OINTMENT [Dovonex] ![Compare how all Medicare Part D PDP plans in GA cover CALCIPOTRIENE 0.005% OINTMENT [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /30Days |
CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp] ![Compare how all Medicare Part D PDP plans in GA cover CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:120 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in GA cover CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in GA cover CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CALCITRIOL 1 MCG/ML SOLUTION ORAL  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CALCIUM ACETATE 667 MG GELCAPSULE [PhosLo] ![Compare how all Medicare Part D PDP plans in GA cover CALCIUM ACETATE 667 MG GELCAPSULE [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CALCIUM ACETATE 667 MG TABLET [PhosLo] ![Compare how all Medicare Part D PDP plans in GA cover CALCIUM ACETATE 667 MG TABLET [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CALQUENCE 100 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
CALQUENCE 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
CAMRESE LO TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CANDESARTAN CILEXETIL 16 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN CILEXETIL 16 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CANDESARTAN CILEXETIL 32 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN CILEXETIL 32 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CANDESARTAN CILEXETIL 4 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN CILEXETIL 4 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CANDESARTAN CILEXETIL 8 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN CILEXETIL 8 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CANDESARTAN-HCTZ 16-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN-HCTZ 16-12.5 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CANDESARTAN-HCTZ 32-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN-HCTZ 32-12.5 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in GA cover CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CAPLYTA 10.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | Q:30 /30Days |
CAPLYTA 21 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | Q:30 /30Days |
CAPLYTA 42 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | Q:30 /30Days |
CAPRELSA 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
CAPRELSA 300 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
CARBAMAZEPINE 100 MG TABLET CHEW  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARBAMAZEPINE 100 MG/5 ML SUSP  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE 200 MG TABLET [Tegretol] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE 200 MG TABLET [Tegretol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE ER 100 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 100 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE ER 200 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 200 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBAMAZEPINE ER 400 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in GA cover CARBAMAZEPINE ER 400 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA 25 MG TABLET [Lodosyn] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA 25 MG TABLET [Lodosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVO 10-100 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVO 10-100 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVO 25-100 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVO 25-100 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVO 25-250 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVO 25-250 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVODOPA 25-100 TABLET [SINEMET] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 25-100 TABLET [SINEMET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA 25-250 TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CARBIDOPA-LEVODOPA 50 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 50 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in GA cover CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CARGLUMIC ACID 200 MG TABLET SUSP TABLET DISPER [Carbaglu] ![Compare how all Medicare Part D PDP plans in GA cover CARGLUMIC ACID 200 MG TABLET SUSP TABLET DISPER [Carbaglu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTEOLOL HCL 1% EYE DROPS  |
2* |
Generic |
$10.00 | $25.00 | None |
CARTIA XT 120MG CAPSULE SA  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARTIA XT 180 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in GA cover CARTIA XT 180 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARTIA XT 240MG CAPSULE SA  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARTIA XT 300 MG CAPSULE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CARVEDILOL 12.5 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in GA cover CARVEDILOL 12.5 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | None |
CARVEDILOL 25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in GA cover CARVEDILOL 25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | None |
CARVEDILOL 3.125 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in GA cover CARVEDILOL 3.125 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | None |
CARVEDILOL 6.25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in GA cover CARVEDILOL 6.25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | None |
CASPOFUNGIN ACETATE 50 MG VIAL [Cancidas] ![Compare how all Medicare Part D PDP plans in GA cover CASPOFUNGIN ACETATE 50 MG VIAL [Cancidas].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CASPOFUNGIN ACETATE 70 MG VIAL [Cancidas] ![Compare how all Medicare Part D PDP plans in GA cover CASPOFUNGIN ACETATE 70 MG VIAL [Cancidas].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAYSTON KIT 75 MG/VIAL  |
5 |
Specialty Tier |
25% | N/A | P Q:84 /56Days |
CEFACLOR 250 MG CAPSULE [Ceclor] ![Compare how all Medicare Part D PDP plans in GA cover CEFACLOR 250 MG CAPSULE [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CEFACLOR 500 MG CAPSULE [Ceclor] ![Compare how all Medicare Part D PDP plans in GA cover CEFACLOR 500 MG CAPSULE [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CEFAZOLIN 1 GM VIAL [Kefzol] ![Compare how all Medicare Part D PDP plans in GA cover CEFAZOLIN 1 GM VIAL [Kefzol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFAZOLIN 10 GM VIAL [Kefzol] ![Compare how all Medicare Part D PDP plans in GA cover CEFAZOLIN 10 GM VIAL [Kefzol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFAZOLIN 500 MG VIAL [Ancef] ![Compare how all Medicare Part D PDP plans in GA cover CEFAZOLIN 500 MG VIAL [Ancef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFDINIR 125 MG/5 ML ORAL SUSPENSION [Omnicef] ![Compare how all Medicare Part D PDP plans in GA cover CEFDINIR 125 MG/5 ML ORAL SUSPENSION [Omnicef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef] ![Compare how all Medicare Part D PDP plans in GA cover CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CEFDINIR 300 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CEFEPIME HCL 1 GM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in GA cover CEFEPIME HCL 1 GM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFEPIME HCL 2 GRAM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in GA cover CEFEPIME HCL 2 GRAM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFIXIME 100 MG/5 ML SUSPENSION [Suprax] ![Compare how all Medicare Part D PDP plans in GA cover CEFIXIME 100 MG/5 ML SUSPENSION [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFIXIME 200 MG/5 ML SUSPENSION [Suprax] ![Compare how all Medicare Part D PDP plans in GA cover CEFIXIME 200 MG/5 ML SUSPENSION [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFIXIME 400 MG CAPSULE [Suprax] ![Compare how all Medicare Part D PDP plans in GA cover CEFIXIME 400 MG CAPSULE [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFOXITIN 1 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in GA cover CEFOXITIN 1 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFOXITIN 10 GM VIAL  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFOXITIN 2 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in GA cover CEFOXITIN 2 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFPODOXIME 100 MG TABLET [Vantin] ![Compare how all Medicare Part D PDP plans in GA cover CEFPODOXIME 100 MG TABLET [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin] ![Compare how all Medicare Part D PDP plans in GA cover CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFPODOXIME 200 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFPODOXIME 50 MG/5 ML SUSPENSION  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFTAZIDIME 1 GM VIAL [Tazidime] ![Compare how all Medicare Part D PDP plans in GA cover CEFTAZIDIME 1 GM VIAL [Tazidime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFTRIAXONE 1 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in GA cover CEFTRIAXONE 1 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFTRIAXONE 10 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in GA cover CEFTRIAXONE 10 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFTRIAXONE 2 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in GA cover CEFTRIAXONE 2 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFTRIAXONE 250 MG VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in GA cover CEFTRIAXONE 250 MG VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFTRIAXONE 500 MG VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in GA cover CEFTRIAXONE 500 MG VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFUROXIME 750 MG FOR INJECTION  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CEFUROXIME AXETIL 250 MG TABLET [Ceftin] ![Compare how all Medicare Part D PDP plans in GA cover CEFUROXIME AXETIL 250 MG TABLET [Ceftin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CEFUROXIME AXETIL 500 MG TABLET [Ceftin] ![Compare how all Medicare Part D PDP plans in GA cover CEFUROXIME AXETIL 500 MG TABLET [Ceftin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in GA cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in GA cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in GA cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in GA cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CELONTIN 300 MG KAPSEAL  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [Keflex] ![Compare how all Medicare Part D PDP plans in GA cover CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [Keflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CEPHALEXIN 250 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [Keflex] ![Compare how all Medicare Part D PDP plans in GA cover CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [Keflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CEPHALEXIN 500 MG CAPSULE  |
2* |
Generic |
$10.00 | $25.00 | None |
CETIRIZINE HCL 1 MG/ML SYRUP SOLUTION [Zyrtec Pre-Filled Spoons] ![Compare how all Medicare Part D PDP plans in GA cover CETIRIZINE HCL 1 MG/ML SYRUP SOLUTION [Zyrtec Pre-Filled Spoons].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CHLORHEXIDINE GLUCONATE 0.12% RINSE  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLOROQUINE PH 250 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLOROQUINE PH 500 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 10 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 100 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 100 MG/ML ORAL CONC  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 200 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 25 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 30 MG/ML ORAL CONC  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORPROMAZINE 50 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CHLORTHALIDONE 25 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CHLORTHALIDONE 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHOLBAM 250 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
CHOLBAM 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
CHOLESTYRAMINE LIGHT PACKET POWDER PACK [Questran Light] ![Compare how all Medicare Part D PDP plans in GA cover CHOLESTYRAMINE LIGHT PACKET POWDER PACK [Questran Light].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CHOLESTYRAMINE PACKET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CICLOPIROX 0.77% CREAM (g) [Loprox] ![Compare how all Medicare Part D PDP plans in GA cover CICLOPIROX 0.77% CREAM (g) [Loprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:90 /28Days |
CICLOPIROX 0.77% GEL  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:100 /28Days |
CICLOPIROX 0.77% TOPICAL SUSPENSION  |
4 |
Non-Preferred Drug |
45% | N/A | Q:60 /28Days |
CICLOPIROX 1% SHAMPOO [Loprox] ![Compare how all Medicare Part D PDP plans in GA cover CICLOPIROX 1% SHAMPOO [Loprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:120 /28Days |
CICLOPIROX 8% SOLUTION [Penlac] ![Compare how all Medicare Part D PDP plans in GA cover CICLOPIROX 8% SOLUTION [Penlac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
Cilastatin 250 MG / Imipenem 250 MG Injection  |
4 |
Non-Preferred Drug |
45% | N/A | None |
Cilastatin 500 MG / Imipenem 500 MG Injection  |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CILOSTAZOL 100 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CILOSTAZOL 50 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CIMDUO 300-300 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CINACALCET HCL 30 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in GA cover CINACALCET HCL 30 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CINACALCET HCL 60 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in GA cover CINACALCET HCL 60 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CINACALCET HCL 90 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in GA cover CINACALCET HCL 90 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CINRYZE 500 UNIT VIAL-DILUENT  |
5 |
Specialty Tier |
25% | N/A | P |
CIPRO 10% SUSPENSION 1 KIT in 1 KIT  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CIPRO 5% SUSPENSION 1 KIT in 1 KIT  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CIPROFLOX-DEXAMETH OTIC SUSPENSION EYE DROPPER [Ciprodex Otic] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOX-DEXAMETH OTIC SUSPENSION EYE DROPPER [Ciprodex Otic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CIPROFLOXACIN 0.2% OTIC SOLUTION DROPERETTE [Cetraxal] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN 0.2% OTIC SOLUTION DROPERETTE [Cetraxal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CIPROFLOXACIN HCL 100 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN HCL 100 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CIPROFLOXACIN HCL 250 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN HCL 250 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CIPROFLOXACIN HCL 500 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN HCL 500 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CIPROFLOXACIN HCL 750 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN HCL 750 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro] ![Compare how all Medicare Part D PDP plans in GA cover CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CITALOPRAM HBR 10 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in GA cover CITALOPRAM HBR 10 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | Q:30 /30Days |
CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa] ![Compare how all Medicare Part D PDP plans in GA cover CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CITALOPRAM HBR 20 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in GA cover CITALOPRAM HBR 20 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | Q:30 /30Days |
CITALOPRAM HBR 40 MG TABLET  |
1* |
Preferred Generic |
$1.00 | $2.50 | Q:30 /30Days |
CLARAVIS 10 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARAVIS 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARAVIS 40 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARITHROMYCIN 250 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARITHROMYCIN 500 MG TABLET [Biaxin] ![Compare how all Medicare Part D PDP plans in GA cover CLARITHROMYCIN 500 MG TABLET [Biaxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLARITHROMYCIN ER 500 MG TABLET ER 24H [Biaxin XL] ![Compare how all Medicare Part D PDP plans in GA cover CLARITHROMYCIN ER 500 MG TABLET ER 24H [Biaxin XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN HCL 300 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN HCL 300 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN HCL 75 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN HCL 75 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CLINDAMYCIN PEDIATR 75 MG/5 ML SOLUTION RECON [Cleocin Pediatric] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PEDIATR 75 MG/5 ML SOLUTION RECON [Cleocin Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLINDAMYCIN PH 1% GEL [ClindaMax] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PH 1% GEL [ClindaMax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:120 /30Days |
CLINDAMYCIN PH 1% SOLUTION  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:120 /30Days |
CLINDAMYCIN PH 300 MG/2 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PH 300 MG/2 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CLINDAMYCIN PH 900 MG/6 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PH 900 MG/6 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CLINDAMYCIN PHOSP 1% LOTION [ClindaMax] ![Compare how all Medicare Part D PDP plans in GA cover CLINDAMYCIN PHOSP 1% LOTION [ClindaMax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:120 /30Days |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX  |
2* |
Generic |
$10.00 | $25.00 | None |
Clindamycin-d5w 300 mg/50 ml  |
4 |
Non-Preferred Drug |
45% | N/A | P |
Clindamycin-d5w 600 mg/50 ml  |
4 |
Non-Preferred Drug |
45% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clindamycin-d5w 900 mg/50 ml  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CLOBAZAM 10 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in GA cover CLOBAZAM 10 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:60 /30Days |
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI] ![Compare how all Medicare Part D PDP plans in GA cover CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:480 /30Days |
CLOBAZAM 20 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in GA cover CLOBAZAM 20 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:60 /30Days |
CLOBETASOL 0.05% CREAM (g) [Temovate] ![Compare how all Medicare Part D PDP plans in GA cover CLOBETASOL 0.05% CREAM (g) [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /28Days |
CLOBETASOL 0.05% GEL [Temovate] ![Compare how all Medicare Part D PDP plans in GA cover CLOBETASOL 0.05% GEL [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /28Days |
CLOBETASOL 0.05% OINTMENT [Temovate E] ![Compare how all Medicare Part D PDP plans in GA cover CLOBETASOL 0.05% OINTMENT [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /28Days |
CLOBETASOL 0.05% SOLUTION [Temovate] ![Compare how all Medicare Part D PDP plans in GA cover CLOBETASOL 0.05% SOLUTION [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:100 /28Days |
CLOBETASOL EMOLLIENT 0.05% CREAM (G) [Temovate E] ![Compare how all Medicare Part D PDP plans in GA cover CLOBETASOL EMOLLIENT 0.05% CREAM (G) [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:120 /28Days |
CLOMIPRAMINE 25 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in GA cover CLOMIPRAMINE 25 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLOMIPRAMINE 50 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in GA cover CLOMIPRAMINE 50 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE 75 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in GA cover CLOMIPRAMINE 75 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:90 /30Days |
CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:90 /30Days |
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:90 /30Days |
CLONAZEPAM 0.5 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 0.5 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:90 /30Days |
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:90 /30Days |
CLONAZEPAM 1 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 1 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:90 /30Days |
CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:300 /30Days |
CLONAZEPAM 2 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in GA cover CLONAZEPAM 2 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:300 /30Days |
CLONIDINE 0.1 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE 0.1 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:4 /28Days |
CLONIDINE 0.2 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE 0.2 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE 0.3 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE 0.3 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:4 /28Days |
CLONIDINE HCL 0.1 MG TABLET [Catapres] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE HCL 0.1 MG TABLET [Catapres].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CLONIDINE HCL 0.2 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
CLONIDINE HCL 0.3 MG TABLET [Catapres] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE HCL 0.3 MG TABLET [Catapres].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
CLONIDINE HCL ER 0.1 MG TABLET ER 12H [Kapvay] ![Compare how all Medicare Part D PDP plans in GA cover CLONIDINE HCL ER 0.1 MG TABLET ER 12H [Kapvay].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in GA cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $2.50 | Q:30 /30Days |
CLORAZEPATE 15 MG TABLET [Tranxene] ![Compare how all Medicare Part D PDP plans in GA cover CLORAZEPATE 15 MG TABLET [Tranxene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:180 /30Days |
CLORAZEPATE 3.75 MG TABLET [Tranxene] ![Compare how all Medicare Part D PDP plans in GA cover CLORAZEPATE 3.75 MG TABLET [Tranxene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:90 /30Days |
CLORAZEPATE 7.5 MG TABLET [Tranxene T-Tab] ![Compare how all Medicare Part D PDP plans in GA cover CLORAZEPATE 7.5 MG TABLET [Tranxene T-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:360 /30Days |
CLOTRIMAZOLE 1% SOLUTION [Lotrimin AF] ![Compare how all Medicare Part D PDP plans in GA cover CLOTRIMAZOLE 1% SOLUTION [Lotrimin AF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:30 /28Days |
CLOTRIMAZOLE 1% TOPICAL CREAM (G) [Mycozyl AC] ![Compare how all Medicare Part D PDP plans in GA cover CLOTRIMAZOLE 1% TOPICAL CREAM (G) [Mycozyl AC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | Q:45 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE 10 MG TROCHE [Mycelex Troche] ![Compare how all Medicare Part D PDP plans in GA cover CLOTRIMAZOLE 10 MG TROCHE [Mycelex Troche].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CLOTRIMAZOLE-BETAMETHASONE CREAM (G) [Lotrisone] ![Compare how all Medicare Part D PDP plans in GA cover CLOTRIMAZOLE-BETAMETHASONE CREAM (G) [Lotrisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:45 /28Days |
CLOTRIMAZOLE-BETAMETHASONE LOT  |
4 |
Non-Preferred Drug |
45% | N/A | Q:60 /28Days |
CLOZAPINE 100 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE 100 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CLOZAPINE 200 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE 200 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CLOZAPINE 25 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE 25 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CLOZAPINE 50 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE 50 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in GA cover CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
COARTEM 20MG-120MG  |
4 |
Non-Preferred Drug |
45% | N/A | None |
COLCHICINE 0.6 MG TABLET [Colcrys] ![Compare how all Medicare Part D PDP plans in GA cover COLCHICINE 0.6 MG TABLET [Colcrys].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
COLESEVELAM 625 MG TABLET [WelChol] ![Compare how all Medicare Part D PDP plans in GA cover COLESEVELAM 625 MG TABLET [WelChol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
COLESEVELAM HCL 3.75 G POWDER PACKET [Welchol Powder] ![Compare how all Medicare Part D PDP plans in GA cover COLESEVELAM HCL 3.75 G POWDER PACKET [Welchol Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
COLISTIMETHATE 150 MG VIAL [Coly-Mycin M] ![Compare how all Medicare Part D PDP plans in GA cover COLISTIMETHATE 150 MG VIAL [Coly-Mycin M].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
COMBIVENT RESPIMAT INHAL SPRAY  |
4 |
Non-Preferred Drug |
45% | N/A | Q:8 /30Days |
COMETRIQ 100 MG DAILY-DOSE PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
COMETRIQ 140 MG DAILY-DOSE PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:112 /28Days |
COMETRIQ 60 MG DAILY-DOSE PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:84 /28Days |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1  |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMPRO 25MG SUPPOSITORY  |
4 |
Non-Preferred Drug |
45% | N/A | None |
CONSTULOSE 10 GM/15 ML SOLUTION  |
2* |
Generic |
$10.00 | $25.00 | None |
COPIKTRA 15 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
COPIKTRA 25 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
CORLANOR 5 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | Q:60 /30Days |
CORLANOR 5 MG/5 ML ORAL SOLUTION  |
4 |
Non-Preferred Drug |
45% | N/A | Q:450 /30Days |
CORLANOR 7.5 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | Q:60 /30Days |
COSENTYX 300 MG DOSE-2 PENS  |
5 |
Specialty Tier |
25% | N/A | P Q:10 /28Days |
COSENTYX 300 MG DOSE-2 SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:10 /28Days |
COSENTYX 75 MG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:3 /28Days |
COTELLIC 20 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:63 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOTTLE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOTTLE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOTTLE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CREON DR 36,000 UNITS CAPSULE  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
CRESEMBA 186 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom] ![Compare how all Medicare Part D PDP plans in GA cover CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal] ![Compare how all Medicare Part D PDP plans in GA cover CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
CROMOLYN SODIUM 4% 40MG 10ML BOTTLE  |
2* |
Generic |
$10.00 | $25.00 | None |
CYCLOBENZAPRINE 10 MG TABLET [Flexeril] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOBENZAPRINE 10 MG TABLET [Flexeril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOBENZAPRINE 5 MG TABLET [Flexeril] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOBENZAPRINE 5 MG TABLET [Flexeril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOPHOSPHAMIDE 25 MG CAPSULE  |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
CYCLOPHOSPHAMIDE 25 MG TABLET [Cytoxan] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOPHOSPHAMIDE 25 MG TABLET [Cytoxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE  |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
CYCLOPHOSPHAMIDE 50 MG TABLET [Cytoxan] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOPHOSPHAMIDE 50 MG TABLET [Cytoxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
CYCLOSPORINE 100MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOSPORINE 25MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOSPORINE MODIFIED 100 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOSPORINE MODIFIED 100 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOSPORINE MODIFIED 25 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOSPORINE MODIFIED 25 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOSPORINE MODIFIED 50 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in GA cover CYCLOSPORINE MODIFIED 50 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOTTLE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYLTEZO(CF) 10 MG/0.2 ML SYRINGEKIT  |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYLTEZO(CF) 20 MG/0.4 ML SYRINGEKIT  |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
CYLTEZO(CF) 40 MG/0.8 ML SYRINGE KIT  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
CYLTEZO(CF) PEN 40 MG/0.8 ML PEN INJECTOR KIT  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
CYLTEZO(CF) PEN CRH-UC-HS 40MG PEN INJECTOR KIT  |
5 |
Specialty Tier |
25% | N/A | P Q:6 /180Days |
CYLTEZO(CF) PEN PSORIASIS 40MG PEN INJECTOR KIT  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /180Days |
CYSTADANE 1 GRAM/1.7 ML POWDER  |
5 |
Specialty Tier |
25% | N/A | None |
CYSTAGON 150MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYSTAGON 50MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | P |
CYSTARAN 0.44% EYE DROPS  |
5 |
Specialty Tier |
25% | N/A | P |