2024 Medicare Part D Plan Formulary Information |
Wellcare Giveback Open (PPO) (H1914-002-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Wellcare Giveback Open (PPO). 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 Wellcare Giveback Open (PPO) (H1914-002-0) Formulary Drugs Starting with the Letter L in Litchfield County, CT: CMS MA Region 2 which includes: CT
|
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LABETALOL HCL 200 MG TABLET [Trandate] ![Compare how all Medicare Part D PDP plans in CT cover LABETALOL HCL 200 MG TABLET [Trandate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LABETALOL HCL 300 MG TABLET [Trandate] ![Compare how all Medicare Part D PDP plans in CT cover LABETALOL HCL 300 MG TABLET [Trandate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LACOSAMIDE 10 MG/ML SOLUTION [Vimpat] ![Compare how all Medicare Part D PDP plans in CT cover LACOSAMIDE 10 MG/ML SOLUTION [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:1200 /30Days |
LACOSAMIDE 100 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in CT cover LACOSAMIDE 100 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
LACOSAMIDE 150 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in CT cover LACOSAMIDE 150 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
LACOSAMIDE 200 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in CT cover LACOSAMIDE 200 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
LACOSAMIDE 50 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in CT cover LACOSAMIDE 50 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:120 /30Days |
LACTULOSE 10 GM/15 ML SOLUTION [Generlac] ![Compare how all Medicare Part D PDP plans in CT cover LACTULOSE 10 GM/15 ML SOLUTION [Generlac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
Lagevrio 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover Lagevrio 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:40 /180Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir] ![Compare how all Medicare Part D PDP plans in CT cover LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LAMIVUDINE 150 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in CT cover LAMIVUDINE 150 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LAMIVUDINE 300 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in CT cover LAMIVUDINE 300 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LAMIVUDINE HBV 100 MG TABLET [Epivir HBV] ![Compare how all Medicare Part D PDP plans in CT cover LAMIVUDINE HBV 100 MG TABLET [Epivir HBV].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMIVUDINE-ZIDOVUDINE TABLET [Combivir] ![Compare how all Medicare Part D PDP plans in CT cover LAMIVUDINE-ZIDOVUDINE TABLET [Combivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE 100 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 100 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 150 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 150 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 200 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 200 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 25 MG DISPER TABLET CHEWABLE [Lamictal CD] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 25 MG DISPER TABLET CHEWABLE [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LAMOTRIGINE 25 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 25 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHEWABLE [Lamictal CD] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE 5 MG DISPER TABLET CHEWABLE [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ER 100 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 100 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ER 200 MG TABLET 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 200 MG TABLET 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ER 25 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 25 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ER 250 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 250 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ER 300 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 300 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ER 50 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ER 50 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in CT cover LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid] ![Compare how all Medicare Part D PDP plans in CT cover LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANSOPRAZOLE DR 30 MG CAPSULE DR [Prevacid] ![Compare how all Medicare Part D PDP plans in CT cover LANSOPRAZOLE DR 30 MG CAPSULE DR [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
LANSOPRAZOLE ODT 15 MG TABLET RAP DR [Prevacid Solutab] ![Compare how all Medicare Part D PDP plans in CT cover LANSOPRAZOLE ODT 15 MG TABLET RAP DR [Prevacid Solutab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LANSOPRAZOLE ODT 30 MG TABLET RAP DR [Prevacid Solutab] ![Compare how all Medicare Part D PDP plans in CT cover LANSOPRAZOLE ODT 30 MG TABLET RAP DR [Prevacid Solutab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LAPATINIB 250 MG TABLET [Tykerb] ![Compare how all Medicare Part D PDP plans in CT cover LAPATINIB 250 MG TABLET [Tykerb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:180 /30Days |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in CT cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEFLUNOMIDE 10 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in CT cover LEFLUNOMIDE 10 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
LEFLUNOMIDE 20 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in CT cover LEFLUNOMIDE 20 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENALIDOMIDE 10 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 10 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 15 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 15 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 2.5 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 2.5 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 20 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 20 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 25 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 25 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 5 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in CT cover LENALIDOMIDE 5 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:28 /28Days |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:30 /30Days |
LENVIMA 12 MG DAILY DOSE CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 12 MG DAILY DOSE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:90 /30Days |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:60 /30Days |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:90 /30Days |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:90 /30Days |
LENVIMA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:30 /30Days |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in CT cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:60 /30Days |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in CT cover Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LETROZOLE 2.5 MG TABLET [Femara] ![Compare how all Medicare Part D PDP plans in CT cover LETROZOLE 2.5 MG TABLET [Femara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in CT cover LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEUCOVORIN CALCIUM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEUCOVORIN CALCIUM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LEUCOVORIN CALCIUM 5 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEUCOVORIN CALCIUM 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in CT cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric] ![Compare how all Medicare Part D PDP plans in CT cover LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in CT cover LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in CT cover LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVALBUTEROL CONC 1.25 MG/0.5 VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in CT cover LEVALBUTEROL CONC 1.25 MG/0.5 VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex] ![Compare how all Medicare Part D PDP plans in CT cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days |
LEVETIRACETAM 1,000 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM 1,000 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVETIRACETAM 100 MG/ML SOLUTION [Keppra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM 100 MG/ML SOLUTION [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVETIRACETAM 250 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM 250 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVETIRACETAM 500 MG TABLET [Roweepra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM 500 MG TABLET [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVETIRACETAM 750 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM 750 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVETIRACETAM ER 500 MG TABLET 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM ER 500 MG TABLET 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM ER 750 MG TABLET 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in CT cover LEVETIRACETAM ER 750 MG TABLET 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVOBUNOLOL 0.5% EYE DROPS [Betagan] ![Compare how all Medicare Part D PDP plans in CT cover LEVOBUNOLOL 0.5% EYE DROPS [Betagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEVOCARNITINE 1 G/10 ML SOLUTION [Carnitor] ![Compare how all Medicare Part D PDP plans in CT cover LEVOCARNITINE 1 G/10 ML SOLUTION [Carnitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVOCARNITINE 330 MG TABLET [Carnitor] ![Compare how all Medicare Part D PDP plans in CT cover LEVOCARNITINE 330 MG TABLET [Carnitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
LEVOCETIRIZINE 2.5 MG/5 ML SOLUTION [Xyzal Solution] ![Compare how all Medicare Part D PDP plans in CT cover LEVOCETIRIZINE 2.5 MG/5 ML SOLUTION [Xyzal Solution].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour] ![Compare how all Medicare Part D PDP plans in CT cover LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEVOFLOXACIN 25 MG/ML SOLUTION [Levaquin] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 25 MG/ML SOLUTION [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOFLOXACIN 500 MG TABLET [Levaquin] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 500 MG TABLET [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOFLOXACIN 500 MG/100 ML-D5W PIGGYBACK [Levaquin] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 500 MG/100 ML-D5W PIGGYBACK [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 750 MG/150 ML-D5W PIGGYBACK [Levaquin] ![Compare how all Medicare Part D PDP plans in CT cover LEVOFLOXACIN 750 MG/150 ML-D5W PIGGYBACK [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEVONOR-ETH ESTRAD 0.1-0.02 MG TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in CT cover LEVONOR-ETH ESTRAD 0.1-0.02 MG TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in CT cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in CT cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVONOR-ETH ESTRAD TRIPHASIC TABLET [Trivora] ![Compare how all Medicare Part D PDP plans in CT cover LEVONOR-ETH ESTRAD TRIPHASIC TABLET [Trivora].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LEVORA-28 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVORA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 125 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 125 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 200 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 200 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 300 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 300 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in CT cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LIDOCAINE 2% VISCOUS SOLUTION [Xylocaine Viscous] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAINE 2% VISCOUS SOLUTION [Xylocaine Viscous].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LIDOCAINE 5% OINTMENT [SOLUPAK] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAINE 5% OINTMENT [SOLUPAK].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:50 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIDOCAINE 5% PATCH [Lidoderm] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAINE 5% PATCH [Lidoderm].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:90 /30Days |
LIDOCAINE HCL 4% SOLUTION [Xylocaine] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAINE HCL 4% SOLUTION [Xylocaine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:50 /30Days |
LIDOCAINE-PRILOCAINE CREAM (G) [SOLUPICC] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAINE-PRILOCAINE CREAM (G) [SOLUPICC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days |
LIDOCAN III 5% PATCH [Tridacaine] ![Compare how all Medicare Part D PDP plans in CT cover LIDOCAN III 5% PATCH [Tridacaine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:90 /30Days |
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox Powder] ![Compare how all Medicare Part D PDP plans in CT cover LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:1800 /30Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in CT cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox] ![Compare how all Medicare Part D PDP plans in CT cover LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
LIOTHYRONINE SOD 25 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in CT cover LIOTHYRONINE SOD 25 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIOTHYRONINE SOD 5 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in CT cover LIOTHYRONINE SOD 5 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in CT cover LIOTHYRONINE SOD 50 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LISDEXAMFETAMINE 10 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 10 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 10 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 10 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 20 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 20 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 20 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 20 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 30 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 30 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 30 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 30 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days |
LISDEXAMFETAMINE 40 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 40 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISDEXAMFETAMINE 40 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 40 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISDEXAMFETAMINE 50 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 50 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISDEXAMFETAMINE 50 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 50 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISDEXAMFETAMINE 60 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 60 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISDEXAMFETAMINE 60 MG CHEWABLE TABLET [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 60 MG CHEWABLE TABLET [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISDEXAMFETAMINE 70 MG CAPSULE [Vyvanse] ![Compare how all Medicare Part D PDP plans in CT cover LISDEXAMFETAMINE 70 MG CAPSULE [Vyvanse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:30 /30Days |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 40 MG TABLET [Zestril] ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 40 MG TABLET [Zestril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL-HCTZ 10-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL-HCTZ 20-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL-HCTZ 20-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LISINOPRIL-HCTZ 20-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LITHIUM 8 MEQ/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM 8 MEQ/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LITHIUM CARBONATE 150 MG CAPSULE CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE 150 MG CAPSULE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE 300 MG CAPSULE [Eskalith] ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE 300 MG CAPSULE [Eskalith].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LITHIUM CARBONATE 600 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE 600 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR] ![Compare how all Medicare Part D PDP plans in CT cover LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LIVALO 1 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LIVALO 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
LIVALO 2 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LIVALO 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIVALO 4 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LIVALO 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days |
LOKELMA 10 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in CT cover LOKELMA 10 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOKELMA 5 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in CT cover LOKELMA 5 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LOPERAMIDE 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CT cover LOPERAMIDE 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in CT cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LOPINAVIR-RITONAVR 100-25MG TABLET [Kaletra] ![Compare how all Medicare Part D PDP plans in CT cover LOPINAVIR-RITONAVR 100-25MG TABLET [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LOPINAVIR-RITONAVR 200-50MG TABLET [Kaletra] ![Compare how all Medicare Part D PDP plans in CT cover LOPINAVIR-RITONAVR 200-50MG TABLET [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
LORAZEPAM 0.5 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in CT cover LORAZEPAM 0.5 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:150 /30Days |
LORAZEPAM 1 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in CT cover LORAZEPAM 1 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LORAZEPAM 2 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in CT cover LORAZEPAM 2 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | Q:150 /30Days |
LORAZEPAM INTENSOL 2 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in CT cover LORAZEPAM INTENSOL 2 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:150 /30Days |
LORBRENA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LORBRENA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:30 /30Days |
LORBRENA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LORBRENA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:90 /30Days |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in CT cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOSARTAN POTASSIUM 100 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN POTASSIUM 100 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 25 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN POTASSIUM 25 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN POTASSIUM 50 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN POTASSIUM 50 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 100-25 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN-HCTZ 100-25 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
LOSARTAN-HCTZ 50-12.5 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in CT cover LOSARTAN-HCTZ 50-12.5 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CT cover Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days |
LOVASTATIN 40 MG TABLET [Mevacor] ![Compare how all Medicare Part D PDP plans in CT cover LOVASTATIN 40 MG TABLET [Mevacor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days |
LOW-OGESTREL-28 TABLET [Low-Ogestrel] ![Compare how all Medicare Part D PDP plans in CT cover LOW-OGESTREL-28 TABLET [Low-Ogestrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOXAPINE 10 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in CT cover LOXAPINE 10 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOXAPINE 25 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in CT cover LOXAPINE 25 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOXAPINE 5 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in CT cover LOXAPINE 5 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LOXAPINE 50 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in CT cover LOXAPINE 50 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LUBIPROSTONE 24 MCG CAPSULE [Amitiza] ![Compare how all Medicare Part D PDP plans in CT cover LUBIPROSTONE 24 MCG CAPSULE [Amitiza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
LUBIPROSTONE 8 MCG CAPSULE [Amitiza] ![Compare how all Medicare Part D PDP plans in CT cover LUBIPROSTONE 8 MCG CAPSULE [Amitiza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUMAKRAS 120 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LUMAKRAS 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LUMAKRAS 320 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LUMAKRAS 320 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in CT cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in CT cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in CT cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LURASIDONE HCL 120 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in CT cover LURASIDONE HCL 120 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:30 /30Days |
LURASIDONE HCL 20 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in CT cover LURASIDONE HCL 20 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:30 /30Days |
LURASIDONE HCL 40 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in CT cover LURASIDONE HCL 40 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:30 /30Days |
LURASIDONE HCL 60 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in CT cover LURASIDONE HCL 60 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:30 /30Days |
LURASIDONE HCL 80 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in CT cover LURASIDONE HCL 80 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:60 /30Days |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in CT cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYLEQ 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in CT cover LYLEQ 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |
LYLLANA 0.025 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in CT cover LYLLANA 0.025 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LYLLANA 0.0375 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in CT cover LYLLANA 0.0375 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LYLLANA 0.05 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in CT cover LYLLANA 0.05 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LYLLANA 0.075 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in CT cover LYLLANA 0.075 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LYLLANA 0.1 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in CT cover LYLLANA 0.1 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:120 /30Days |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:120 /30Days |
LYRICA CR 165 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in CT cover LYRICA CR 165 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:90 /30Days |
LYRICA CR 330 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in CT cover LYRICA CR 330 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:60 /30Days |
LYRICA CR 82.5 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in CT cover LYRICA CR 82.5 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYSODREN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYSODREN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
LYTGOBI 12 MG DOSE (3X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYTGOBI 12 MG DOSE (3X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LYTGOBI 16 MG DOSE (4X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYTGOBI 16 MG DOSE (4X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LYTGOBI 20 MG DOSE (5X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYTGOBI 20 MG DOSE (5X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in CT cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $0.00 | None |