2024 Medicare Part D Plan Formulary Information |
UPMC for Life HMO Rx Enhanced (HMO) (H3907-006-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for UPMC for Life HMO Rx Enhanced (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. Call drug plan for more details. |
The UPMC for Life HMO Rx Enhanced (HMO) (H3907-006-0) Formulary Drugs Starting with the Letter C in Wyoming County, PA: CMS MA Region 6 which includes: PA
|
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 PA cover CABERGOLINE 0.5 MG TABLET [Dostinex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CABLIVI 11 MG KIT ![Compare how all Medicare Part D PDP plans in PA cover CABLIVI 11 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CABOMETYX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CABOMETYX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CABOMETYX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CABOMETYX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CABOMETYX 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CABOMETYX 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CALCIPOTRIENE 0.005% CREAM (G) [Dovonex] ![Compare how all Medicare Part D PDP plans in PA cover CALCIPOTRIENE 0.005% CREAM (G) [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
CALCIPOTRIENE 0.005% OINTMENT [Dovonex] ![Compare how all Medicare Part D PDP plans in PA cover CALCIPOTRIENE 0.005% OINTMENT [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp] ![Compare how all Medicare Part D PDP plans in PA cover CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in PA cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | 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 PA cover CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CALCITRIOL 1 MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover CALCITRIOL 1 MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CALCIUM ACETATE 667 MG CAPSULE [PhosLo] ![Compare how all Medicare Part D PDP plans in PA cover CALCIUM ACETATE 667 MG CAPSULE [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CALCIUM ACETATE 667 MG TABLET [PhosLo] ![Compare how all Medicare Part D PDP plans in PA cover CALCIUM ACETATE 667 MG TABLET [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CALQUENCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CALQUENCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
CALQUENCE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CALQUENCE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
CAMILA 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in PA cover CAMILA 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CAMRESE LO TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAMRESE LO TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CAMZYOS 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAMZYOS 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CAMZYOS 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAMZYOS 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CAMZYOS 2.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAMZYOS 2.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAMZYOS 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAMZYOS 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CANDESARTAN CILEXETIL 16 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in PA cover CANDESARTAN CILEXETIL 16 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CANDESARTAN CILEXETIL 32 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in PA cover CANDESARTAN CILEXETIL 32 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CANDESARTAN CILEXETIL 4 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in PA cover CANDESARTAN CILEXETIL 4 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CANDESARTAN CILEXETIL 8 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in PA cover CANDESARTAN CILEXETIL 8 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CANDESARTAN-HCTZ 16-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | None |
CANDESARTAN-HCTZ 32-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | None |
CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in PA cover CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CAPLYTA 10.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAPLYTA 10.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CAPLYTA 21 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAPLYTA 21 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
CAPLYTA 42 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CAPLYTA 42 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPRELSA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPRELSA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:60 /30Days |
CAPRELSA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPRELSA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CAPTOPRIL 100 MG TABLET [Capoten] ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 100 MG TABLET [Capoten].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CAPTOPRIL 12.5 MG TABLET [Capoten] ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 12.5 MG TABLET [Capoten].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CAPTOPRIL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CAPTOPRIL 50 MG TABLET [Capoten] ![Compare how all Medicare Part D PDP plans in PA cover CAPTOPRIL 50 MG TABLET [Capoten].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBAMAZEPINE 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE 200 MG TABLET [Tegretol] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE 200 MG TABLET [Tegretol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE ER 100 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 100 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE ER 200 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 200 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBAMAZEPINE ER 400 MG TABLET 12H [Tegretol -XR] ![Compare how all Medicare Part D PDP plans in PA cover CARBAMAZEPINE ER 400 MG TABLET 12H [Tegretol -XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBIDOPA 25 MG TABLET [Lodosyn] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA 25 MG TABLET [Lodosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CARBIDOPA-LEVO 10-100 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVO 10-100 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVO 25-100 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVO 25-100 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVO 25-250 MG ODT TABLET RAPDIS [Parcopa] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVO 25-250 MG ODT TABLET RAPDIS [Parcopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET].](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 |
CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 25-100 TABLET [SINEMET] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25-100 TABLET [SINEMET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 25-250 TABLET ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 25-250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 50 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 50 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in PA cover CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARGLUMIC ACID 200 MG TABLET SUSP TABLET DISPER [Carbaglu] ![Compare how all Medicare Part D PDP plans in PA cover CARGLUMIC ACID 200 MG TABLET SUSP TABLET DISPER [Carbaglu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CARISOPRODOL 350 MG TABLET [Vanadom] ![Compare how all Medicare Part D PDP plans in PA cover CARISOPRODOL 350 MG TABLET [Vanadom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CARTEOLOL HCL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover CARTEOLOL HCL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARTIA XT 180 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 180 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARTIA XT 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CARTIA XT 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CARVEDILOL 12.5 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 12.5 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CARVEDILOL 25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CARVEDILOL 3.125 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 3.125 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CARVEDILOL 6.25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in PA cover CARVEDILOL 6.25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CASPOFUNGIN ACETATE 50 MG VIAL [Cancidas] ![Compare how all Medicare Part D PDP plans in PA cover CASPOFUNGIN ACETATE 50 MG VIAL [Cancidas].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CASPOFUNGIN ACETATE 70 MG VIAL [Cancidas] ![Compare how all Medicare Part D PDP plans in PA cover CASPOFUNGIN ACETATE 70 MG VIAL [Cancidas].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CAYSTON KIT 75 MG/VIAL ![Compare how all Medicare Part D PDP plans in PA cover CAYSTON KIT 75 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR 250 MG CAPSULE [Ceclor] ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR 250 MG CAPSULE [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFACLOR 500 MG CAPSULE [Ceclor] ![Compare how all Medicare Part D PDP plans in PA cover CEFACLOR 500 MG CAPSULE [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFADROXIL 1 GM TABLET [Duricef] ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 1 GM TABLET [Duricef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFADROXIL 250 MG/5 ML ORAL SUSPENSION [Duricef] ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 250 MG/5 ML ORAL SUSPENSION [Duricef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFADROXIL 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEFADROXIL 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFADROXIL 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFAZOLIN 1 GM VIAL [Kefzol] ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 1 GM VIAL [Kefzol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFAZOLIN 10 GM VIAL [Kefzol] ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 10 GM VIAL [Kefzol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFAZOLIN 500 MG VIAL [Ancef] ![Compare how all Medicare Part D PDP plans in PA cover CEFAZOLIN 500 MG VIAL [Ancef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFDINIR 125 MG/5 ML ORAL SUSPENSION [Omnicef] ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR 125 MG/5 ML ORAL SUSPENSION [Omnicef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef] ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEFDINIR 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEFEPIME HCL 1 GM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in PA cover CEFEPIME HCL 1 GM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFEPIME HCL 2 GRAM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in PA cover CEFEPIME HCL 2 GRAM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFIXIME 400 MG CAPSULE [Suprax] ![Compare how all Medicare Part D PDP plans in PA cover CEFIXIME 400 MG CAPSULE [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFOTETAN 1GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in PA cover CEFOTETAN 1GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFOTETAN 2GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in PA cover CEFOTETAN 2GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFOXITIN 1 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN 1 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFOXITIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFOXITIN 2 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in PA cover CEFOXITIN 2 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFPODOXIME 100 MG TABLET [Vantin] ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME 100 MG TABLET [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin] ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFPODOXIME 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFPODOXIME 50 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFPODOXIME 50 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFPROZIL 125 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 125 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFPROZIL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEFPROZIL 250 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 250 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEFPROZIL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CEFPROZIL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEFTAZIDIME 1 GM VIAL [Tazidime] ![Compare how all Medicare Part D PDP plans in PA cover CEFTAZIDIME 1 GM VIAL [Tazidime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN ![Compare how all Medicare Part D PDP plans in PA cover CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN ![Compare how all Medicare Part D PDP plans in PA cover CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTRIAXONE 1 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 1 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTRIAXONE 10 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 10 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTRIAXONE 2 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 2 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTRIAXONE 250 MG VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 250 MG VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFTRIAXONE 500 MG VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in PA cover CEFTRIAXONE 500 MG VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME 1.5 GM/VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFUROXIME 750 MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME 750 MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CEFUROXIME AXETIL 250 MG TABLET [Ceftin] ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 250 MG TABLET [Ceftin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEFUROXIME AXETIL 500 MG TABLET [Ceftin] ![Compare how all Medicare Part D PDP plans in PA cover CEFUROXIME AXETIL 500 MG TABLET [Ceftin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in PA cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in PA cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in PA cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in PA cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [Keflex] ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [Keflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEPHALEXIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [Keflex] ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [Keflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CEPHALEXIN 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CEPHALEXIN 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CERDELGA 84 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CERDELGA 84 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
CETIRIZINE HCL 1 MG/ML SOLUTION [Zyrtec Syrup] ![Compare how all Medicare Part D PDP plans in PA cover CETIRIZINE HCL 1 MG/ML SOLUTION [Zyrtec Syrup].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CEVIMELINE HCL 30 MG CAPSULE [Evoxac] ![Compare how all Medicare Part D PDP plans in PA cover CEVIMELINE HCL 30 MG CAPSULE [Evoxac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHEMET 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHEMET 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CHENODAL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHENODAL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CHLORDIAZEPO-AMITRIPTYL 5-12.5 ![Compare how all Medicare Part D PDP plans in PA cover CHLORDIAZEPO-AMITRIPTYL 5-12.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORDIAZEPOXIDE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHLORDIAZEPOXIDE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORDIAZEPOXIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHLORDIAZEPOXIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:120 /30Days |
CHLORDIAZEPOXIDE 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHLORDIAZEPOXIDE 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:120 /30Days |
CHLORHEXIDINE GLUCONATE 0.12% RINSE ![Compare how all Medicare Part D PDP plans in PA cover CHLORHEXIDINE GLUCONATE 0.12% RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CHLOROQUINE PH 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PH 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLOROQUINE PH 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLOROQUINE PH 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORPROMAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORPROMAZINE 100 MG TABLET [Thorazine] ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 100 MG TABLET [Thorazine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORPROMAZINE 100 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 100 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CHLORPROMAZINE 200 MG TABLET [Thorazine] ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 200 MG TABLET [Thorazine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORPROMAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORPROMAZINE 30 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 30 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 50 MG TABLET [Thorazine] ![Compare how all Medicare Part D PDP plans in PA cover CHLORPROMAZINE 50 MG TABLET [Thorazine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CHLORTHALIDONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CHLORTHALIDONE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CHLORTHALIDONE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CHLORZOXAZONE 500 MG TABLET [Relax-DS] ![Compare how all Medicare Part D PDP plans in PA cover CHLORZOXAZONE 500 MG TABLET [Relax-DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CHOLBAM 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHOLBAM 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CHOLBAM 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CHOLBAM 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CHOLESTYRAMINE LIGHT POWDER PACKET [Questran Light] ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE LIGHT POWDER PACKET [Questran Light].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CHOLESTYRAMINE PACKET ![Compare how all Medicare Part D PDP plans in PA cover CHOLESTYRAMINE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CIBINQO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIBINQO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CIBINQO 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIBINQO 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
CIBINQO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIBINQO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CICLOPIROX 0.77% CREAM (G) [Loprox] ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 0.77% CREAM (G) [Loprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CICLOPIROX 0.77% GEL ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 0.77% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days |
CICLOPIROX 0.77% TOPICAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 0.77% TOPICAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days |
CICLOPIROX 1% SHAMPOO [Loprox] ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 1% SHAMPOO [Loprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:120 /30Days |
CICLOPIROX 8% SOLUTION [Penlac] ![Compare how all Medicare Part D PDP plans in PA cover CICLOPIROX 8% SOLUTION [Penlac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
Cilastatin 250 MG / Imipenem 250 MG Injection ![Compare how all Medicare Part D PDP plans in PA cover Cilastatin 250 MG / Imipenem 250 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Cilastatin 500 MG / Imipenem 500 MG Injection ![Compare how all Medicare Part D PDP plans in PA cover Cilastatin 500 MG / Imipenem 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CILOSTAZOL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CILOSTAZOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CILOSTAZOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CIMDUO 300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CIMDUO 300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CIMETIDINE 300 MG TABLET [Tagamet] ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE 300 MG TABLET [Tagamet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CIMETIDINE 400 MG TABLET [Tagamet] ![Compare how all Medicare Part D PDP plans in PA cover CIMETIDINE 400 MG TABLET [Tagamet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in PA cover Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:3 /28Days |
CIMZIA 200 MG/ML SYRINGE KIT ![Compare how all Medicare Part D PDP plans in PA cover CIMZIA 200 MG/ML SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:3 /28Days |
CINACALCET HCL 30 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in PA cover CINACALCET HCL 30 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CINACALCET HCL 60 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in PA cover CINACALCET HCL 60 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
CINACALCET HCL 90 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in PA cover CINACALCET HCL 90 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
CINRYZE 500 UNIT VIAL-DILUENT ![Compare how all Medicare Part D PDP plans in PA cover CINRYZE 500 UNIT VIAL-DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:20 /30Days |
CIPROFLOX-DEXAMETH OTIC SUSPENSION EYE DROPPER [Ciprodex Otic] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOX-DEXAMETH OTIC SUSPENSION EYE DROPPER [Ciprodex Otic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN 0.2% OTIC SOLUTION DROPERETTE [Cetraxal] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 0.2% OTIC SOLUTION DROPERETTE [Cetraxal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CIPROFLOXACIN 200 MG/100ML-D5W PIGGYBACK [Cipro] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN 200 MG/100ML-D5W PIGGYBACK [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CIPROFLOXACIN HCL 250 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 250 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CIPROFLOXACIN HCL 500 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 500 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CIPROFLOXACIN HCL 750 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in PA cover CIPROFLOXACIN HCL 750 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CITALOPRAM HBR 10 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 10 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days |
CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa] ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:600 /30Days |
CITALOPRAM HBR 20 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 20 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
CITALOPRAM HBR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CITALOPRAM HBR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
CLARAVIS 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARAVIS 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLARAVIS 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CLARAVIS 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLARITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLARITHROMYCIN 500 MG TABLET [Biaxin] ![Compare how all Medicare Part D PDP plans in PA cover CLARITHROMYCIN 500 MG TABLET [Biaxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLARITHROMYCIN ER 500 MG TABLET ER 24H [Biaxin XL] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | None |
CLENPIQ 175 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLENPIQ 175 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLENPIQ SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLENPIQ SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLEOCIN 100 MG VAGINAL OVULE SUPP.VAG ![Compare how all Medicare Part D PDP plans in PA cover CLEOCIN 100 MG VAGINAL OVULE SUPP.VAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin] ![Compare how all Medicare Part D PDP plans in PA cover CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:45 /30Days |
CLINDACIN ETZ 1% PLEDGET MED. SWAB [PledgaClin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDACIN ETZ 1% PLEDGET MED. SWAB [PledgaClin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLINDAMYCIN HCL 300 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 300 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLINDAMYCIN HCL 75 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN HCL 75 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLINDAMYCIN PEDIATR 75 MG/5 ML SOLUTION RECON [Cleocin Pediatric] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | None |
CLINDAMYCIN PH 1% GEL [ClindaMax] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PH 1% GEL [ClindaMax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
CLINDAMYCIN PH 1% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PH 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:120 /30Days |
CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLINDAMYCIN PH 900 MG/6 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PH 900 MG/6 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PHOSP 1% LOTION [ClindaMax] ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSP 1% LOTION [ClindaMax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in PA cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
Clindamycin-d5w 300 mg/50 ml ![Compare how all Medicare Part D PDP plans in PA cover Clindamycin-d5w 300 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Clindamycin-d5w 600 mg/50 ml ![Compare how all Medicare Part D PDP plans in PA cover Clindamycin-d5w 600 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Clindamycin-d5w 900 mg/50 ml ![Compare how all Medicare Part D PDP plans in PA cover Clindamycin-d5w 900 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CLINIMIX 4.25%-5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 4.25%-5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX 5%-15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX 5%-15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX E 4.25%-10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 4.25%-10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX E 4.25%-5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 4.25%-5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINIMIX E 5%-15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINIMIX E 5%-15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLINISOL 15% SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CLINISOL 15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLOBAZAM 10 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in PA cover CLOBAZAM 10 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI] ![Compare how all Medicare Part D PDP plans in PA cover CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:480 /30Days |
CLOBAZAM 20 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in PA cover CLOBAZAM 20 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
CLOBETASOL 0.05% CREAM (g) [Temovate] ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% CREAM (g) [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:180 /30Days |
CLOBETASOL 0.05% GEL [Temovate] ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% GEL [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:120 /30Days |
CLOBETASOL 0.05% OINTMENT [Temovate E] ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% OINTMENT [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:180 /30Days |
CLOBETASOL 0.05% SOLUTION [Temovate Scalp] ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL 0.05% SOLUTION [Temovate Scalp].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:120 /30Days |
CLOBETASOL EMOLLIENT 0.05% CREAM (G) [Temovate E] ![Compare how all Medicare Part D PDP plans in PA cover CLOBETASOL EMOLLIENT 0.05% CREAM (G) [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE 25 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE 25 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLOMIPRAMINE 50 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE 50 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLOMIPRAMINE 75 MG CAPSULE [Anafranil] ![Compare how all Medicare Part D PDP plans in PA cover CLOMIPRAMINE 75 MG CAPSULE [Anafranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:90 /30Days |
CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:90 /30Days |
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:90 /30Days |
CLONAZEPAM 0.5 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 0.5 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:90 /30Days |
CLONAZEPAM 1 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 1 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:300 /30Days |
CLONAZEPAM 2 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in PA cover CLONAZEPAM 2 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:300 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLONIDINE 0.1 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE 0.1 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CLONIDINE 0.2 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE 0.2 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CLONIDINE 0.3 MG/DAY PATCH [Catapres-TTS] ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE 0.3 MG/DAY PATCH [Catapres-TTS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CLONIDINE HCL 0.1 MG TABLET [Catapres] ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL 0.1 MG TABLET [Catapres].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLONIDINE HCL 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLONIDINE HCL 0.3 MG TABLET [Catapres] ![Compare how all Medicare Part D PDP plans in PA cover CLONIDINE HCL 0.3 MG TABLET [Catapres].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLONIDINE HCL ER 0.1 MG TABLET ER 12H [Kapvay] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | Q:120 /30Days |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in PA cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
CLORAZEPATE 15 MG TABLET [Tranxene] ![Compare how all Medicare Part D PDP plans in PA cover CLORAZEPATE 15 MG TABLET [Tranxene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
CLORAZEPATE 3.75 MG TABLET [Tranxene] ![Compare how all Medicare Part D PDP plans in PA cover CLORAZEPATE 3.75 MG TABLET [Tranxene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days |
CLORAZEPATE 7.5 MG TABLET [Tranxene T-Tab] ![Compare how all Medicare Part D PDP plans in PA cover CLORAZEPATE 7.5 MG TABLET [Tranxene T-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE 1% SOLUTION [Lotrimin AF] ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 1% SOLUTION [Lotrimin AF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:90 /30Days |
CLOTRIMAZOLE 1% TOPICAL CREAM (G) [Mycozyl AC] ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 1% TOPICAL CREAM (G) [Mycozyl AC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLOTRIMAZOLE 10 MG TROCHE [Mycelex Troche] ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE 10 MG TROCHE [Mycelex Troche].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CLOTRIMAZOLE-BETAMETHASONE CREAM (G) [Lotrisone] ![Compare how all Medicare Part D PDP plans in PA cover CLOTRIMAZOLE-BETAMETHASONE CREAM (G) [Lotrisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLOZAPINE 100 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 100 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLOZAPINE 200 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 200 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:150 /30Days |
CLOZAPINE 25 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 25 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLOZAPINE 50 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE 50 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days |
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:90 /30Days |
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:90 /30Days |
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:150 /30Days |
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in PA cover CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:90 /30Days |
COARTEM 20MG-120MG ![Compare how all Medicare Part D PDP plans in PA cover COARTEM 20MG-120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CODEINE SULFATE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CODEINE SULFATE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
CODEINE SULFATE 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CODEINE SULFATE 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
CODEINE SULFATE 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CODEINE SULFATE 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
COLCHICINE 0.6 MG TABLET [Colcrys] ![Compare how all Medicare Part D PDP plans in PA cover COLCHICINE 0.6 MG TABLET [Colcrys].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
COLESEVELAM 625 MG TABLET [WelChol] ![Compare how all Medicare Part D PDP plans in PA cover COLESEVELAM 625 MG TABLET [WelChol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
COLESEVELAM HCL 3.75 G POWDER PACKET [Welchol Powder] ![Compare how all Medicare Part D PDP plans in PA 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 |
$100.00 | $300.00 | None |
COLESTIPOL HCL 1 GM TABLET [Colestid] ![Compare how all Medicare Part D PDP plans in PA cover COLESTIPOL HCL 1 GM TABLET [Colestid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
COLESTIPOL HCL GRANULES PACKET [Colestid] ![Compare how all Medicare Part D PDP plans in PA cover COLESTIPOL HCL GRANULES PACKET [Colestid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLISTIMETHATE 150 MG VIAL [Coly-Mycin M] ![Compare how all Medicare Part D PDP plans in PA cover COLISTIMETHATE 150 MG VIAL [Coly-Mycin M].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
COMBIVENT RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover COMBIVENT RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:8 /30Days |
COMETRIQ 100 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover COMETRIQ 100 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:56 /28Days |
COMETRIQ 140 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover COMETRIQ 140 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:112 /28Days |
COMETRIQ 60 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover COMETRIQ 60 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:84 /28Days |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in PA cover COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in PA cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CONSTULOSE 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CONSTULOSE 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
COPIKTRA 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COPIKTRA 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
COPIKTRA 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover COPIKTRA 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /30Days |
CORLANOR 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORLANOR 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CORLANOR 5 MG/5 ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover CORLANOR 5 MG/5 ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:450 /30Days |
CORLANOR 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CORLANOR 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
CORTROPHIN GEL 400 UNIT/5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover CORTROPHIN GEL 400 UNIT/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:35 /28Days |
COSENTYX 300 MG DOSE-2 PENS ![Compare how all Medicare Part D PDP plans in PA cover COSENTYX 300 MG DOSE-2 PENS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:10 /28Days |
COSENTYX 300 MG DOSE-2 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover COSENTYX 300 MG DOSE-2 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:10 /28Days |
COSENTYX 75 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover COSENTYX 75 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:2.5 /28Days |
COSENTYX UNOREADY 300 MG PEN INJCTR ![Compare how all Medicare Part D PDP plans in PA cover COSENTYX UNOREADY 300 MG PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:10 /28Days |
COTELLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover COTELLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:63 /28Days |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CREON DR 36,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CREON DR 36,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CRESEMBA 186 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRESEMBA 186 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
CRESEMBA 74.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CRESEMBA 74.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | None |
CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom] ![Compare how all Medicare Part D PDP plans in PA cover CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal] ![Compare how all Medicare Part D PDP plans in PA cover CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P |
CROMOLYN SODIUM 4% 40MG 10ML BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover CROMOLYN SODIUM 4% 40MG 10ML BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CUVRIOR 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover CUVRIOR 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:304 /30Days |
CYCLOBENZAPRINE 10 MG TABLET [Flexeril] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE 10 MG TABLET [Flexeril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CYCLOBENZAPRINE 5 MG TABLET [Flexeril] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOBENZAPRINE 5 MG TABLET [Flexeril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CYCLOPHOSPHAMIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOPHOSPHAMIDE 25 MG TABLET [Cytoxan] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 25 MG TABLET [Cytoxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CYCLOPHOSPHAMIDE 50 MG TABLET [Cytoxan] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOPHOSPHAMIDE 50 MG TABLET [Cytoxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
CYCLOSPORINE 0.05% EYE EMULS DROPERETTE [Restasis] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 0.05% EYE EMULS DROPERETTE [Restasis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYCLOSPORINE MODIFIED 100 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE MODIFIED 100 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYCLOSPORINE MODIFIED 25 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE MODIFIED 25 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYCLOSPORINE MODIFIED 50 MG CAPSULE [Neoral] ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE MODIFIED 50 MG CAPSULE [Neoral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | P |
CYLTEZO(CF) 10 MG/0.2 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) 10 MG/0.2 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | 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 ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) 20 MG/0.4 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:2 /28Days |
CYLTEZO(CF) 40 MG/0.8 ML SYRINGE KIT ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) 40 MG/0.8 ML SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:4 /28Days |
CYLTEZO(CF) PEN 40 MG/0.8 ML PEN INJECTOR KIT ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) PEN 40 MG/0.8 ML PEN INJECTOR KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:4 /28Days |
CYLTEZO(CF) PEN CRH-UC-HS 40MG PEN INJECTOR KIT ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) PEN CRH-UC-HS 40MG PEN INJECTOR KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:12 /365Days |
CYLTEZO(CF) PEN PSORIASIS 40MG PEN INJECTOR KIT ![Compare how all Medicare Part D PDP plans in PA cover CYLTEZO(CF) PEN PSORIASIS 40MG PEN INJECTOR KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:8 /365Days |
CYPROHEPTADINE 4 MG TABLET [Periactin] ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE 4 MG TABLET [Periactin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in PA cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CYRED EQ 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in PA cover CYRED EQ 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$0.00 | $0.00 | None |
CYSTADROPS 0.37% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover CYSTADROPS 0.37% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:20 /28Days |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYSTARAN 0.44% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover CYSTARAN 0.44% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
33% | N/A | P Q:60 /28Days |