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 E in CMS PDP Region 10 which includes: GA
|
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
E.E.S. 400 FILMTAB TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ECONAZOLE NITRATE 1% CREAM (G) [Spectazole] ![Compare how all Medicare Part D PDP plans in GA cover ECONAZOLE NITRATE 1% CREAM (G) [Spectazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:85 /28Days |
EDURANT 27.5mg/1  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EFAVIR-EMTRI-TENOF 600-200-300 TABLET [Atripla] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIR-EMTRI-TENOF 600-200-300 TABLET [Atripla].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIR-LAMIV-TENOF 400-300-300 TABLET [SYMFI LO] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIR-LAMIV-TENOF 400-300-300 TABLET [SYMFI LO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EFAVIR-LAMIV-TENOF 600-300-300 TABLET [SYMFI] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIR-LAMIV-TENOF 600-300-300 TABLET [SYMFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EFAVIRENZ 200 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIRENZ 200 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EFAVIRENZ 50 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIRENZ 50 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EFAVIRENZ 600 MG TABLET [Sustiva] ![Compare how all Medicare Part D PDP plans in GA cover EFAVIRENZ 600 MG TABLET [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ELIQUIS 2.5 MG TABLET  |
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 |
ELIQUIS 5 MG STARTER PACK  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ELIQUIS 5 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ELMIRON 100mg GELATIN COATED 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EMCYT 140MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EMEND 125 MG POWDER PACKET  |
4 |
Non-Preferred Drug |
45% | N/A | P |
EMGALITY 120 MG/ML PEN INJCTR  |
4 |
Non-Preferred Drug |
45% | N/A | P Q:2 /30Days |
EMGALITY 120 MG/ML SYRINGE  |
4 |
Non-Preferred Drug |
45% | N/A | P Q:2 /30Days |
EMGALITY 300 MG (100 MG X3SYR) SYRINGE  |
4 |
Non-Preferred Drug |
45% | N/A | P Q:3 /30Days |
Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy] ![Compare how all Medicare Part D PDP plans in GA cover Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H  |
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 |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EMTRICITABINE 200 MG CAPSULE [Emtriva] ![Compare how all Medicare Part D PDP plans in GA cover EMTRICITABINE 200 MG CAPSULE [Emtriva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EMTRICITABINE-TENOFV 100-150MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in GA cover EMTRICITABINE-TENOFV 100-150MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 133-200MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in GA cover EMTRICITABINE-TENOFV 133-200MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 167-250MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in GA cover EMTRICITABINE-TENOFV 167-250MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 200-300MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in GA cover EMTRICITABINE-TENOFV 200-300MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRIVA 10MG/ML SOLUTION  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EMVERM 100 MG TABLET CHEW  |
5 |
Specialty Tier |
25% | N/A | None |
ENALAPRIL MALEATE 10 MG TABLET [Vasotec] ![Compare how all Medicare Part D PDP plans in GA cover ENALAPRIL MALEATE 10 MG TABLET [Vasotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ENALAPRIL MALEATE 2.5 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
ENALAPRIL MALEATE 20 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 |
ENALAPRIL MALEATE 5 MG TABLET  |
2* |
Generic |
$10.00 | $25.00 | None |
ENALAPRIL-HCTZ 10-25 MG TABLET [Vaseretic] ![Compare how all Medicare Part D PDP plans in GA cover ENALAPRIL-HCTZ 10-25 MG TABLET [Vaseretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ENALAPRIL-HCTZ 5-12.5 MG TABLET [Vaseretic] ![Compare how all Medicare Part D PDP plans in GA cover ENALAPRIL-HCTZ 5-12.5 MG TABLET [Vaseretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ENBREL 25 MG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
ENBREL 25 MG/0.5 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
ENBREL 50 MG/ML MINI CARTRIDGE  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
ENBREL 50 MG/ML SURECLICK PEN INJECTOR  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
ENBREL 50 MG/ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
ENDOCET 10MG-325MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days |
ENDOCET 2.5-325 MG TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in GA cover ENDOCET 2.5-325 MG TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days |
ENDOCET 5/325 TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENDOCET 7.5-325MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days |
ENGERIX B INJECTION  |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
ENGERIX-B 20 MCG/ML SYRINGE  |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
ENGERIX-B 20 MCG/ML VIAL  |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
ENOXAPARIN 100 MG/ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 100 MG/ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:28 /28Days |
ENOXAPARIN 120 MG/0.8 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 120 MG/0.8 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:22 /28Days |
ENOXAPARIN 150 MG/ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 150 MG/ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:28 /28Days |
ENOXAPARIN 30 MG/0.3 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 30 MG/0.3 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:17 /28Days |
ENOXAPARIN 40 MG/0.4 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 40 MG/0.4 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:11 /28Days |
ENOXAPARIN 60 MG/0.6 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 60 MG/0.6 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:17 /28Days |
ENOXAPARIN 80 MG/0.8 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in GA cover ENOXAPARIN 80 MG/0.8 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:22 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENTACAPONE 200 MG TABLET [Comtan] ![Compare how all Medicare Part D PDP plans in GA cover ENTACAPONE 200 MG TABLET [Comtan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ENTECAVIR 0.5 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in GA cover ENTECAVIR 0.5 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ENTECAVIR 1 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in GA cover ENTECAVIR 1 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ENTRESTO 24 MG-26 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days |
ENTRESTO 49 MG-51 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days |
ENTRESTO 97 MG-103 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days |
ENULOSE 10 GM/15 ML SOLUTION  |
2* |
Generic |
$10.00 | $25.00 | None |
EPCLUSA 150-37.5 MG PELLET PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EPCLUSA 200 MG-50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
EPCLUSA 200-50 MG PELLET PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
EPCLUSA 400 MG-100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPIDIOLEX 100 MG/ML SOLUTION  |
5 |
Specialty Tier |
25% | N/A | P |
EPINASTINE HCL 0.05% EYE DROPS  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EPINEPHRINE 0.15 MG AUTO-INJCT [Twinject] ![Compare how all Medicare Part D PDP plans in GA cover EPINEPHRINE 0.15 MG AUTO-INJCT [Twinject].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:2 /30Days |
EPINEPHRINE 0.15 MG AUTO-INJECT  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:2 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT  |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:2 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT [Twinject] ![Compare how all Medicare Part D PDP plans in GA cover EPINEPHRINE 0.3 MG AUTO-INJECT [Twinject].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:2 /30Days |
EPITOL 200MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EPLERENONE 25 MG TABLET [Inspra] ![Compare how all Medicare Part D PDP plans in GA cover EPLERENONE 25 MG TABLET [Inspra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EPLERENONE 50 MG TABLET [Inspra] ![Compare how all Medicare Part D PDP plans in GA cover EPLERENONE 50 MG TABLET [Inspra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EPRONTIA 25 MG/ML SOLUTION  |
4 |
Non-Preferred Drug |
45% | N/A | P |
Ergotamine-caffeine 1-100mg tablet  |
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 |
ERIVEDGE 150 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLEADA 240 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLEADA 60 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
ERLOTINIB HCL 100 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in GA cover ERLOTINIB HCL 100 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLOTINIB HCL 150 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in GA cover ERLOTINIB HCL 150 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERLOTINIB HCL 25 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in GA cover ERLOTINIB HCL 25 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
ERTAPENEM 1 GRAM VIAL [Invanz] ![Compare how all Medicare Part D PDP plans in GA cover ERTAPENEM 1 GRAM VIAL [Invanz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERY 2% PADS 2% 60 PADS JAR  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROCIN 250 MG FILMTAB TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROCIN LACT 500 MG VIAL  |
4 |
Non-Preferred Drug |
45% | N/A | P |
ERYTHROMYCIN 0.5% EYE OINTMENT [Romycin] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN 0.5% EYE OINTMENT [Romycin].](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 |
ERYTHROMYCIN 2% GEL [Erygel] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN 2% GEL [Erygel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN 2% SOLUTION  |
2* |
Generic |
$10.00 | $25.00 | None |
ERYTHROMYCIN 200 MG/5 ML ORAL SUSPENSION [EryPed] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN 200 MG/5 ML ORAL SUSPENSION [EryPed].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN 250 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN 400 MG/5 ML ORAL SUSPENSION [EryPed] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN 400 MG/5 ML ORAL SUSPENSION [EryPed].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN 500 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN DR 250 MG CAPSULE DR [ERYC] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN DR 250 MG CAPSULE DR [ERYC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN DR 250 MG TABLET DR [Ery-Tab] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN DR 250 MG TABLET DR [Ery-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN DR 333 MG TABLET DR [Ery-Tab] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN DR 333 MG TABLET DR [Ery-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN DR 500 MG TABLET DR [Ery-Tab] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN DR 500 MG TABLET DR [Ery-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ERYTHROMYCIN ES 400 MG TABLET [E.E.S.] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN ES 400 MG TABLET [E.E.S.].](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 |
ERYTHROMYCIN-BENZOYL GEL [Benzamycin] ![Compare how all Medicare Part D PDP plans in GA cover ERYTHROMYCIN-BENZOYL GEL [Benzamycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESBRIET 267 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
ESCITALOPRAM 10 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in GA cover ESCITALOPRAM 10 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ESCITALOPRAM 20 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in GA cover ESCITALOPRAM 20 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ESCITALOPRAM 5 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in GA cover ESCITALOPRAM 5 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $25.00 | None |
ESCITALOPRAM OXALATE 5 MG/5 ML SOLUTION [Lexapro] ![Compare how all Medicare Part D PDP plans in GA cover ESCITALOPRAM OXALATE 5 MG/5 ML SOLUTION [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESOMEPRAZOLE MAG DR 20 MG CAPSULE DR [Nexium 24HR Clear Minis] ![Compare how all Medicare Part D PDP plans in GA cover ESOMEPRAZOLE MAG DR 20 MG CAPSULE DR [Nexium 24HR Clear Minis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | Q:30 /30Days |
ESOMEPRAZOLE MAG DR 40 MG CAPSULE DR [Nexium] ![Compare how all Medicare Part D PDP plans in GA cover ESOMEPRAZOLE MAG DR 40 MG CAPSULE DR [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESTARYLLA 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in GA cover ESTARYLLA 0.25-0.035 MG TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESTRADIOL 0.01% CREAM/APPL [Estrace] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.01% CREAM/APPL [Estrace].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ESTRADIOL 0.025 MG PATCH(1/WK) [FemPatch] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.025 MG PATCH(1/WK) [FemPatch].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 0.0375MG PATCH(1/WKClimara] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.0375MG PATCH(1/WKClimara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
ESTRADIOL 0.05 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.05 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
ESTRADIOL 0.06 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.06 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
ESTRADIOL 0.075 MG PATCH(1/WKClimara] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.075 MG PATCH(1/WKClimara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
ESTRADIOL 0.1 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 0.1 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P Q:4 /28Days |
ESTRADIOL 0.5 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | P |
ESTRADIOL 1 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | P |
ESTRADIOL 10 MCG VAGINAL INSRT  |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESTRADIOL 2MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | P |
ESTRADIOL 50 MG/5 ML VIAL [Delestrogen] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL 50 MG/5 ML VIAL [Delestrogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ESTRADIOL VALERATE 100 MG/5 ML VIAL [Gynogen LA] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL VALERATE 100 MG/5 ML VIAL [Gynogen LA].](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 |
ESTRADIOL VALERATE 200 MG/5 ML VIAL [Delestrogen] ![Compare how all Medicare Part D PDP plans in GA cover ESTRADIOL VALERATE 200 MG/5 ML VIAL [Delestrogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ETHAMBUTOL HCL 400 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Ethambutol Hydrochloride 100mg/1  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETHOSUXIMIDE 250 MG CAPSULE [Zarontin] ![Compare how all Medicare Part D PDP plans in GA cover ETHOSUXIMIDE 250 MG CAPSULE [Zarontin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETHOSUXIMIDE 250 MG/5 ML SOLUTION [Zarontin] ![Compare how all Medicare Part D PDP plans in GA cover ETHOSUXIMIDE 250 MG/5 ML SOLUTION [Zarontin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA] ![Compare how all Medicare Part D PDP plans in GA cover ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ETHYNODIOL-ETH ESTRA 1MG-50MCG [ZOVIA] ![Compare how all Medicare Part D PDP plans in GA cover ETHYNODIOL-ETH ESTRA 1MG-50MCG [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
ETODOLAC 200 MG CAPSULE [Lodine] ![Compare how all Medicare Part D PDP plans in GA cover ETODOLAC 200 MG CAPSULE [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETODOLAC 300 MG CAPSULE [Lodine] ![Compare how all Medicare Part D PDP plans in GA cover ETODOLAC 300 MG CAPSULE [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETODOLAC 400 MG TABLET [Lodine] ![Compare how all Medicare Part D PDP plans in GA cover ETODOLAC 400 MG TABLET [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
ETODOLAC 500 MG TABLET [Lodine] ![Compare how all Medicare Part D PDP plans in GA cover ETODOLAC 500 MG TABLET [Lodine].](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 |
ETRAVIRINE 100 MG TABLET [INTELENCE] ![Compare how all Medicare Part D PDP plans in GA cover ETRAVIRINE 100 MG TABLET [INTELENCE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
ETRAVIRINE 200 MG TABLET [INTELENCE] ![Compare how all Medicare Part D PDP plans in GA cover ETRAVIRINE 200 MG TABLET [INTELENCE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EUTHYROX 100 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 112 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 125 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 137 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 150 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 175 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 200 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 25 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 50 MCG TABLET  |
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 |
EUTHYROX 75 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EUTHYROX 88 MCG TABLET  |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EVEROLIMUS 0.25 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 0.25 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | P |
EVEROLIMUS 0.5 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 0.5 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 0.75 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 0.75 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 1 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 1 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 10 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 10 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 2 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 2 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 2.5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 2.5 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 3 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 3 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 5 MG TABLET [Afinitor].](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 |
EVEROLIMUS 5 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 5 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 7.5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in GA cover EVEROLIMUS 7.5 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVOTAZ 300 MG-150 MG TABLET  |
4 |
Non-Preferred Drug |
45% | N/A | None |
EXEMESTANE 25 MG TABLET [Aromasin] ![Compare how all Medicare Part D PDP plans in GA cover EXEMESTANE 25 MG TABLET [Aromasin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | N/A | None |
EXKIVITY 40 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
EZETIMIBE 10 MG TABLET [Zetia] ![Compare how all Medicare Part D PDP plans in GA cover EZETIMIBE 10 MG TABLET [Zetia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
EZETIMIBE-SIMVASTATIN 10-10 MG TABLET [Vytorin] ![Compare how all Medicare Part D PDP plans in GA cover EZETIMIBE-SIMVASTATIN 10-10 MG TABLET [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:30 /30Days |
EZETIMIBE-SIMVASTATIN 10-20 MG TABLET [Vytorin] ![Compare how all Medicare Part D PDP plans in GA cover EZETIMIBE-SIMVASTATIN 10-20 MG TABLET [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:30 /30Days |
EZETIMIBE-SIMVASTATIN 10-40 MG TABLET [Vytorin] ![Compare how all Medicare Part D PDP plans in GA cover EZETIMIBE-SIMVASTATIN 10-40 MG TABLET [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:30 /30Days |
EZETIMIBE-SIMVASTATIN 10-80 MG TABLET [Vytorin] ![Compare how all Medicare Part D PDP plans in GA cover EZETIMIBE-SIMVASTATIN 10-80 MG TABLET [Vytorin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:30 /30Days |