A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search

2024 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

SilverScript SmartSaver (PDP) (S5601-179-0)
Tier 1 (339)
Tier 2 (1138)
Tier 3 (195)
Tier 4 (1378)
Tier 5 (593)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2024 Medicare Part D Plan Formulary Information
SilverScript SmartSaver (PDP) (S5601-179-0)
Benefits & Contact Info           
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 SilverScript SmartSaver (PDP) (S5601-179-0)
Formulary Drugs Starting with the Letter T

in CMS PDP Region 4 which includes: NJ
Drugs Starting with Letter T

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
TABLOID 40 MG TABLET   4 Non-Preferred Drug 50%50%None
TABRECTA 150 MG TABLET   5 Specialty Tier 29%N/AP Q:112
/28Days
TABRECTA 200 MG TABLET   5 Specialty Tier 29%N/AP Q:112
/28Days
TACROLIMUS 0.03% OINTMENT [Protopic]   4 Non-Preferred Drug 50%50%Q:60
/30Days
TACROLIMUS 0.1% OINTMENT [Protopic]   4 Non-Preferred Drug 50%50%Q:60
/30Days
TACROLIMUS 0.5 MG CAPSULE (IR) [Prograf]   4 Non-Preferred Drug 50%50%P
TACROLIMUS 1 MG CAPSULE (IR) [Prograf]   4 Non-Preferred Drug 50%50%P
TACROLIMUS 5 MG CAPSULE (IR) [Prograf]   4 Non-Preferred Drug 50%50%P
TADALAFIL 20 MG TABLET [Cialis]   5 Specialty Tier 29%N/AP
TAFINLAR 10 MG TABLET FOR SUSPENSION   5 Specialty Tier 29%N/AP Q:900
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TAFINLAR 50 MG CAPSULE   5 Specialty Tier 29%N/AP Q:120
/30Days
TAFINLAR 75 MG CAPSULE   5 Specialty Tier 29%N/AP Q:120
/30Days
TAGRISSO 40 MG TABLET   5 Specialty Tier 29%N/AP Q:30
/30Days
TAGRISSO 80 MG TABLET   5 Specialty Tier 29%N/AP Q:30
/30Days
TALZENNA 0.1 MG CAPSULE   5 Specialty Tier 29%N/AP Q:30
/30Days
TALZENNA 0.25 MG CAPSULE   5 Specialty Tier 29%N/AP Q:90
/30Days
TALZENNA 0.35 MG CAPSULE   5 Specialty Tier 29%N/AP Q:30
/30Days
TALZENNA 0.5 MG CAPSULE   5 Specialty Tier 29%N/AP Q:30
/30Days
TALZENNA 0.75 MG CAPSULE   5 Specialty Tier 29%N/AP Q:30
/30Days
TALZENNA 1 MG CAPSULE   5 Specialty Tier 29%N/AP Q:30
/30Days
TAMOXIFEN 10 MG TABLET [Nolvadex]   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TAMOXIFEN 20 MG TABLET [Nolvadex]   2 Generic $5.00$15.00None
TAMSULOSIN HCL 0.4 MG CAPSULE [Flomax]   1* Preferred Generic $0.00$0.00Q:60
/30Days
TARINA 24 FE 1 MG-20 MCG TABLET   2 Generic $5.00$15.00None
TARINA FE 1-20 EQ TABLET   2 Generic $5.00$15.00None
Tasigna 150mg/1 4 BLISTER PACK per CARTON / 28 CAPSULE per BLISTER PACK   5 Specialty Tier 29%N/AP Q:112
/28Days
TASIGNA 200 MG CAPSULE   5 Specialty Tier 29%N/AP Q:112
/28Days
TASIGNA 50 MG CAPSULE   5 Specialty Tier 29%N/AP Q:120
/30Days
TASIMELTEON 20 MG CAPSULE [HETLIOZ]   5 Specialty Tier 29%N/AP Q:30
/30Days
TAZAROTENE 0.05% GEL [TAZORAC]   2 Generic $5.00$15.00P Q:100
/30Days
TAZAROTENE 0.1% CREAM [Tazorac]   2 Generic $5.00$15.00P Q:60
/30Days
TAZAROTENE 0.1% GEL [TAZORAC]   2 Generic $5.00$15.00P Q:100
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TAZICEF 1GM VIAL   4 Non-Preferred Drug 50%50%None
TAZICEF 2 GRAM VIAL   4 Non-Preferred Drug 50%50%None
TAZICEF 6 GRAM VIAL   4 Non-Preferred Drug 50%50%None
TAZORAC 0.05% CREAM (G)   4 Non-Preferred Drug 50%50%P Q:60
/30Days
TAZTIA XT 120 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TAZTIA XT 180 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TAZTIA XT 240 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TAZTIA XT 300 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TAZTIA XT 360 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TAZVERIK 200 MG TABLET   5 Specialty Tier 29%N/AP Q:240
/30Days
TDVAX VIAL   1* Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Teflaro 400mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE   5 Specialty Tier 29%N/ANone
Teflaro 600mg/20mL 10 VIAL, SINGLE-DOSE per CARTON / 20 mL in 1 VIAL, SINGLE-DOSE   5 Specialty Tier 29%N/ANone
TELMISARTAN 20 MG TABLET [Micardis]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN 40 MG TABLET [Micardis]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN 80 MG TABLET [Micardis]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN-AMLODIPINE 40-10 TABLET [Twynsta]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN-AMLODIPINE 40-5 MG TABLET [Twynsta]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN-AMLODIPINE 80-10 TABLET [Twynsta]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TELMISARTAN-AMLODIPINE 80-5 MG TABLET [Twynsta]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TELMISARTAN-HCTZ 40-12.5 MG TABLET [Micardis HCT]   2 Generic $5.00$15.00Q:30
/30Days
TELMISARTAN-HCTZ 80-12.5 MG TABLET [Micardis HCT]   2 Generic $5.00$15.00Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TELMISARTAN-HCTZ 80-25 MG TABLET [Micardis HCT]   2 Generic $5.00$15.00Q:30
/30Days
TEMAZEPAM 15 MG CAPSULE [Restoril]   4 Non-Preferred Drug 50%50%P Q:30
/30Days
TEMAZEPAM 22.5 MG CAPSULE [Restoril]   4 Non-Preferred Drug 50%50%P Q:30
/30Days
TEMAZEPAM 30 MG CAPSULE [Restoril]   4 Non-Preferred Drug 50%50%P Q:30
/30Days
TEMAZEPAM 7.5 MG CAPSULE [Restoril]   4 Non-Preferred Drug 50%50%P Q:30
/30Days
TENIVAC SYRINGE   1* Preferred Generic $0.00$0.00None
TENIVAC VIAL   1* Preferred Generic $0.00$0.00None
TENOFOVIR DISOP FUM 300 MG TABLET [Viread]   4 Non-Preferred Drug 50%50%None
TEPMETKO 225 MG TABLET   5 Specialty Tier 29%N/AP Q:60
/30Days
TERAZOSIN 1 MG CAPSULE   1* Preferred Generic $0.00$0.00None
TERAZOSIN 10 MG CAPSULE [Hytrin]   1* Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TERAZOSIN 2 MG CAPSULE   1* Preferred Generic $0.00$0.00None
TERAZOSIN 5 MG CAPSULE [Hytrin]   1* Preferred Generic $0.00$0.00None
TERBINAFINE HCL 250 MG TABLET [Terbinex]   2 Generic $5.00$15.00Q:90
/365Days
TERBUTALINE SULFATE 2.5 MG TABLET [Brethine]   4 Non-Preferred Drug 50%50%None
TERBUTALINE SULFATE 5 MG TABLET [Brethine]   4 Non-Preferred Drug 50%50%None
TERCONAZOLE 0.4% CREAM WITH APPLICATOR   2 Generic $5.00$15.00None
TERCONAZOLE 0.8% CREAM   2 Generic $5.00$15.00None
TERCONAZOLE 80MG SUPPOSITORY VAGINAL   4 Non-Preferred Drug 50%50%None
TERIPARATIDE 620 MCG/2.48 ML PEN INJECTOR [Forteo]   5 Specialty Tier 29%N/AP
TESTOSTERON ENAN 1,000 MG/5 ML VIAL [Delatestryl]   2 Generic $5.00$15.00P
TESTOSTERONE 1.62% (2.5 G) GEL PACKET [AndroGel]   4 Non-Preferred Drug 50%50%P Q:150
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TESTOSTERONE 1.62% GEL MD PUMP [AndroGel]   4 Non-Preferred Drug 50%50%P Q:150
/30Days
TESTOSTERONE 1.62%(1.25 G) GEL PACKET [AndroGel]   4 Non-Preferred Drug 50%50%P Q:150
/30Days
TESTOSTERONE 10 MG GEL MD PUMP [FORTESTA]   4 Non-Preferred Drug 50%50%P Q:120
/30Days
TESTOSTERONE 12.5 MG/1.25 GRAM GEL MD PMP [Vogelxo]   4 Non-Preferred Drug 50%50%P Q:300
/30Days
TESTOSTERONE 25 MG/2.5 GM GEL PACKET [Vogelxo]   4 Non-Preferred Drug 50%50%P Q:300
/30Days
TESTOSTERONE 30 MG/1.5 ML SOL MD PUMP [AXIRON]   2 Generic $5.00$15.00P Q:180
/30Days
TESTOSTERONE 50 MG/5 GRAM GEL PACKET [Vogelxo]   4 Non-Preferred Drug 50%50%P Q:300
/30Days
Testosterone cyp 100 mg/ml   2 Generic $5.00$15.00P
TESTOSTERONE CYP 2,000 MG/10ML VIAL [Virilon]   2 Generic $5.00$15.00P
TESTOSTERONE CYP 200 MG/ML VIAL [Virilon]   2 Generic $5.00$15.00P
TETRABENAZINE 12.5 MG TABLET [Xenazine]   5 Specialty Tier 29%N/AP Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TETRABENAZINE 25 MG TABLET [Xenazine]   5 Specialty Tier 29%N/AP Q:120
/30Days
TETRACYCLINE 250 MG CAPSULE [Panmycin]   4 Non-Preferred Drug 50%50%None
TETRACYCLINE 500 MG CAPSULE [Sumycin]   4 Non-Preferred Drug 50%50%None
TEXACORT 2.5% SOLUTION   4 Non-Preferred Drug 50%50%None
THALOMID 100 MG CAPSULE   5 Specialty Tier 29%N/AP Q:28
/28Days
THALOMID 150 MG CAPSULE   5 Specialty Tier 29%N/AP Q:56
/28Days
THALOMID 200 MG CAPSULE   5 Specialty Tier 29%N/AP Q:56
/28Days
THALOMID 50 MG CAPSULE   5 Specialty Tier 29%N/AP Q:28
/28Days
THEOPHYLLINE 80 MG/15 ML SOLUTION   2 Generic $5.00$15.00None
THEOPHYLLINE ER 300 MG TABLET   4 Non-Preferred Drug 50%50%None
THEOPHYLLINE ER 400 MG TABLET 24H [Uniphyl]   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
THEOPHYLLINE ER 450 MG TABLET 12H   4 Non-Preferred Drug 50%50%None
THEOPHYLLINE ER 600 MG TABLET 24H [Uniphyl]   2 Generic $5.00$15.00None
THIORIDAZINE 10 MG TABLET   2 Generic $5.00$15.00P
THIORIDAZINE 100MG TABLET   2 Generic $5.00$15.00P
THIORIDAZINE 25 MG TABLET   2 Generic $5.00$15.00P
THIORIDAZINE 50 MG TABLET   2 Generic $5.00$15.00P
THIOTHIXENE 1 MG CAPSULE [Navane]   4 Non-Preferred Drug 50%50%None
THIOTHIXENE 10 MG CAPSULE [Navane]   4 Non-Preferred Drug 50%50%None
THIOTHIXENE 2 MG CAPSULE [Navane]   4 Non-Preferred Drug 50%50%None
THIOTHIXENE 5 MG CAPSULE [Navane]   4 Non-Preferred Drug 50%50%None
TIADYLT ER 120 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TIADYLT ER 180 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TIADYLT ER 240 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TIADYLT ER 300 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TIADYLT ER 360 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TIADYLT ER 420 MG CAPSULE SA 24H [Tiazac]   2 Generic $5.00$15.00None
TIAGABINE HCL 12 MG TABLET [Gabitril]   4 Non-Preferred Drug 50%50%None
TIAGABINE HCL 16 MG TABLET [Gabitril]   4 Non-Preferred Drug 50%50%None
TIAGABINE HCL 2 MG TABLET [Gabitril]   4 Non-Preferred Drug 50%50%None
TIAGABINE HCL 4 MG TABLET [Gabitril]   4 Non-Preferred Drug 50%50%None
TIBSOVO 250 MG TABLET   5 Specialty Tier 29%N/AP
TICOVAC 1.2 MCG/0.25 ML SYRINGE   1* Preferred Generic $0.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TICOVAC 2.4 MCG/0.5 ML SYRINGE   1* Preferred Generic $0.00$0.00None
TIGECYCLINE 50 MG VIAL [Tygacil]   5 Specialty Tier 29%N/ANone
TILIA FE 28 TABLET [Tri-Legest Fe]   3 Preferred Brand 24%24%None
TIMOLOL 0.25% GEL-SOLUTION [Timoptic-XE]   4 Non-Preferred Drug 50%50%None
TIMOLOL 0.5% EYE DROPS   4 Non-Preferred Drug 50%50%None
TIMOLOL 0.5% GEL-SOLUTION [Timoptic-XE]   4 Non-Preferred Drug 50%50%None
TIMOLOL MALEATE 0.25% EYE DROPS [Timoptic Ocumeter]   1* Preferred Generic $0.00$0.00None
TIMOLOL MALEATE 0.5% EYE DROPS [Timoptic Ocumeter]   1* Preferred Generic $0.00$0.00None
TIMOLOL MALEATE 10MG TABLET   2 Generic $5.00$15.00None
TIMOLOL MALEATE 20MG TABLET   1* Preferred Generic $0.00$0.00None
TIMOLOL MALEATE 5MG TABLET   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TINIDAZOLE 250 MG TABLET [Tindamax]   2 Generic $5.00$15.00None
TINIDAZOLE 500 MG TABLET [Tindamax]   2 Generic $5.00$15.00None
TIVICAY 10 MG TABLET   3 Preferred Brand 24%24%None
TIVICAY 25 MG TABLET   5 Specialty Tier 29%N/ANone
TIVICAY 50 MG TABLET   5 Specialty Tier 29%N/ANone
TIVICAY PD 5 MG TABLET FOR SUSPENSION   5 Specialty Tier 29%N/ANone
TIZANIDINE HCL 2 MG CAPSULE [Zanaflex]   4 Non-Preferred Drug 50%50%None
TIZANIDINE HCL 2 MG TABLET   2 Generic $5.00$15.00None
TIZANIDINE HCL 4 MG CAPSULE [Zanaflex]   2 Generic $5.00$15.00None
TIZANIDINE HCL 4 MG TABLET   2 Generic $5.00$15.00None
TIZANIDINE HCL 6 MG CAPSULE [Zanaflex]   4 Non-Preferred Drug 50%50%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOBRADEX EYE OINTMENT   4 Non-Preferred Drug 50%50%None
TOBRADEX ST 0.3-0.05% EYE DROP EYE DROPPER   4 Non-Preferred Drug 50%50%None
TOBRAMYCIN 0.3% EYE DROPS [Tobrex]   2 Generic $5.00$15.00Q:30
/30Days
TOBRAMYCIN 10 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate]   4 Non-Preferred Drug 50%50%None
TOBRAMYCIN 300 MG/5 ML AMPULE [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate]   5 Specialty Tier 29%N/AP Q:280
/56Days
TOBRAMYCIN 40 MG/ML VIAL [Bethkis, Tobi, Tobi Podhaler, Tobramycin Sulfate]   4 Non-Preferred Drug 50%50%None
TOBRAMYCIN-DEXAMETH OPTH SUSP   4 Non-Preferred Drug 50%50%None
TOLTERODINE TART ER 2 MG CAPSULE 24H [Detrol LA]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TOLTERODINE TART ER 4 MG CAPSULE 24H [Detrol LA]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TOLTERODINE TARTRATE 1 MG TABLET [Detrol]   2 Generic $5.00$15.00Q:60
/30Days
TOLTERODINE TARTRATE 2 MG TABLET [Detrol]   2 Generic $5.00$15.00Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOPIRAMATE 100 MG TABLET [Topiragen]   2 Generic $5.00$15.00Q:120
/30Days
TOPIRAMATE 15 MG SPRINKLE CAPSULE   2 Generic $5.00$15.00None
TOPIRAMATE 200 MG TABLET [Topiragen]   2 Generic $5.00$15.00Q:60
/30Days
TOPIRAMATE 25 MG TABLET [Topiragen]   2 Generic $5.00$15.00Q:90
/30Days
Topiramate 25mg/1   2 Generic $5.00$15.00None
TOPIRAMATE 50 MG TABLET [Topiragen]   2 Generic $5.00$15.00Q:90
/30Days
TOPIRAMATE ER 100 MG CAPSULE ER 24H [Trokendi XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 100 MG CAPSULE SPR 24 [Qudexy XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 150 MG CAPSULE SPR 24 [Qudexy XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 200 MG CAPSULE 24H [Trokendi XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 200 MG CAPSULE SPR 24 [Qudexy XR]   4 Non-Preferred Drug 50%50%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOPIRAMATE ER 25 MG CAPSULE ER 24H [Trokendi XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 25 MG CAPSULE SPR 24 [Qudexy XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 50 MG CAPSULE ER 24H [Trokendi XR]   4 Non-Preferred Drug 50%50%None
TOPIRAMATE ER 50 MG CAPSULE SPR 24 [Qudexy XR]   4 Non-Preferred Drug 50%50%None
TOREMIFENE CITRATE 60 MG TABLET [Fareston]   5 Specialty Tier 29%N/AP
TORSEMIDE 10 MG TABLET   2 Generic $5.00$15.00None
TORSEMIDE 100 MG TABLET   2 Generic $5.00$15.00None
TORSEMIDE 20 MG TABLET [SOAANZ]   2 Generic $5.00$15.00None
TORSEMIDE 5 MG TABLET [Demadex]   2 Generic $5.00$15.00None
TOUJEO MAX SOLOSTAR 300UNIT/ML INSULN PEN   3 Preferred Brand 24%24%None
TOUJEO SOLOSTAR 300 UNITS/ML   3 Preferred Brand 24%24%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TOVET EMOLLIENT 0.05% FOAM [Olux-E]   4 Non-Preferred Drug 50%50%Q:100
/30Days
TPN ELECTROLYTES16.5/25.4 VIAL   4 Non-Preferred Drug 50%50%P
TRACLEER 32 MG TABLET FOR SUSPENSION TABLET SUSP   5 Specialty Tier 29%N/AP Q:120
/30Days
TRADJENTA 5 MG TABLET   3 Preferred Brand 24%24%Q:30
/30Days
TRAMADOL ER 100 MG TABLET TBMP 24HR [Ultram ER]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRAMADOL ER 200 MG TABLET TBMP 24HR [Ultram ER]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRAMADOL ER 300 MG TABLET TBMP 24HR [Ultram ER]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRAMADOL HCL 50 MG TABLET [Ultram]   2 Generic $5.00$15.00Q:240
/30Days
TRAMADOL HCL ER 100 MG TABLET   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRAMADOL HCL ER 200 MG TABLET   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRAMADOL HCL ER 300 MG Tablet ER 24H [Ultram ER]   4 Non-Preferred Drug 50%50%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRAMADOL-ACETAMINOPHN 37.5-325 TABLET [Ultracet]   2 Generic $5.00$15.00Q:240
/30Days
TRANDOLAPRIL 1 MG TABLET   2 Generic $5.00$15.00None
TRANDOLAPRIL 2 MG TABLET [Mavik]   2 Generic $5.00$15.00None
TRANDOLAPRIL 4 MG TABLET [Mavik]   2 Generic $5.00$15.00None
TRANDOLAPRIL-VERAPAMIL ER 1-240 MG   2 Generic $5.00$15.00None
TRANDOLAPRIL-VERAPAMIL ER 2-180 MG   2 Generic $5.00$15.00None
TRANDOLAPRIL-VERAPAMIL ER 2-240 MG   2 Generic $5.00$15.00None
TRANDOLAPRIL-VERAPAMIL ER 4-240 MG   4 Non-Preferred Drug 50%50%None
TRANEXAMIC ACID 650 MG TABLET [Lysteda]   2 Generic $5.00$15.00None
TRANYLCYPROMINE SULF 10 MG TABLET [Parnate]   4 Non-Preferred Drug 50%50%None
TRAVASOL 10% SOLUTION VIAFLEX   4 Non-Preferred Drug 50%50%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRAVOPROST 0.004% EYE DROPS [Travatan Z]   4 Non-Preferred Drug 50%50%None
TRAZODONE 100 MG TABLET [Desyrel]   1* Preferred Generic $0.00$0.00None
TRAZODONE 150 MG TABLET [Desyrel]   1* Preferred Generic $0.00$0.00None
TRAZODONE 300 MG TABLET [Desyrel]   4 Non-Preferred Drug 50%50%None
TRAZODONE 50 MG TABLET [Desyrel]   1* Preferred Generic $0.00$0.00None
TRECATOR 250MG TABLET   4 Non-Preferred Drug 50%50%None
TRELEGY ELLIPTA 100-62.5-25   3 Preferred Brand 24%24%Q:60
/30Days
TRELEGY ELLIPTA 200-62.5-25 BLST W/DEV   3 Preferred Brand 24%24%Q:60
/30Days
TRESIBA 100 UNIT/ML VIAL   3 Preferred Brand 24%24%None
TRESIBA FLEXTOUCH 100 UNITS/ML   3 Preferred Brand 24%24%None
TRESIBA FLEXTOUCH 200 UNITS/ML   3 Preferred Brand 24%24%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Tretinoin 0.0004 MG/MG Topical Gel   4 Non-Preferred Drug 50%50%P Q:50
/30Days
TRETINOIN 0.01% GEL [Tretin-X]   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 0.025% CREAM (G) [Tretin-X]   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 0.025% GEL [Tretin-X]   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 0.05% CREAM   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 0.05% GEL [Atralin]   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 0.1% CREAM   4 Non-Preferred Drug 50%50%P Q:45
/30Days
TRETINOIN 10MG CAPSULE   5 Specialty Tier 29%N/ANone
TRETINOIN GEL MICRO 0.1% TUBE [Retin-A Micro]   4 Non-Preferred Drug 50%50%P Q:50
/30Days
TRI-ESTARYLLA TABLET [Trinessa]   2 Generic $5.00$15.00None
TRI-LEGEST FE 5-7-9-7 TABLET   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRI-LO-ESTARYLLA TABLET [Trinessa Lo]   2 Generic $5.00$15.00None
TRI-LO-SPRINTEC TABLET   2 Generic $5.00$15.00None
TRI-MILI 28 TABLET [Trinessa]   2 Generic $5.00$15.00None
TRI-NYMYO 28 TABLET [Trinessa]   2 Generic $5.00$15.00None
TRI-SPRINTEC 7DAYSX3 28 TABLET   2 Generic $5.00$15.00None
TRI-VYLIBRA 28 TABLET [Trinessa]   2 Generic $5.00$15.00None
TRI-VYLIBRA LO TABLET [Trinessa Lo]   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.025% CREAM   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.025% LOTION [Kenalog]   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.025% OINT   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.1% CREAM (G) [Triderm]   2 Generic $5.00$15.00Q:454
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIAMCINOLONE 0.1% LOTION [Kenalog]   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.1% OINTMENT [Triderm]   2 Generic $5.00$15.00None
TRIAMCINOLONE 0.1% PASTE (G) [Oralone]   2 Generic $5.00$15.00None
TRIAMCINOLONE ACETONIDE 0.05% OINTMENT 15GM TUBE   2 Generic $5.00$15.00None
Triamcinolone Acetonide 5mg/g 1 TUBE per CARTON / 15 g in 1 TUBE   2 Generic $5.00$15.00None
TRIAMTERENE-HCTZ 37.5-25 MG CAPSULE [Dyazide]   1* Preferred Generic $0.00$0.00None
TRIAMTERENE-HCTZ 37.5-25 MG TABLET [Maxzide-25]   1* Preferred Generic $0.00$0.00None
TRIAMTERENE-HCTZ 75-50 MG TABLET   1* Preferred Generic $0.00$0.00None
TRIAZOLAM 0.125 MG TABLET [Halcion]   4 Non-Preferred Drug 50%50%P Q:60
/30Days
TRIENTINE HCL 250 MG CAPSULE [Syprine]   5 Specialty Tier 29%N/AP
TRIFLUOPERAZINE 1 MG TABLET   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIFLUOPERAZINE HCL 2MG TABLET   2 Generic $5.00$15.00None
TRIFLUOPERAZINE HCL 5MG TABLET   2 Generic $5.00$15.00None
TRIFLUOPERAZINE HCL USP 10MG TABLET (100 CT)   4 Non-Preferred Drug 50%50%None
TRIFLURIDINE 1% OPTH SOLUTION 7.5ML BOTTLE   2 Generic $5.00$15.00None
TRIHEXYPHENIDYL 2 MG TABLET [Artane]   2 Generic $5.00$15.00P
TRIHEXYPHENIDYL 5 MG TABLET [Artane]   2 Generic $5.00$15.00P
Trihexyphenidyl Hydrochloride 2mg/5mL 473 mL in 1 BOTTLE   4 Non-Preferred Drug 50%50%P
TRIJARDY XR 10-5-1,000 MG TABLET BP 24H   3 Preferred Brand 24%24%Q:30
/30Days
TRIJARDY XR 12.5-2.5-1,000 MG TABLET BP 24H   3 Preferred Brand 24%24%Q:60
/30Days
TRIJARDY XR 25-5-1,000 MG TABLET BP 24H   3 Preferred Brand 24%24%Q:30
/30Days
TRIJARDY XR 5-2.5-1,000 MG TABLET BP 24H   3 Preferred Brand 24%24%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRIKAFTA 100-50-75 MG/75MG GRANULES PACKET SQ   5 Specialty Tier 29%N/AP Q:56
/28Days
TRIKAFTA 100/50/75 MG-150 MG TABLET SEQ   5 Specialty Tier 29%N/AP Q:84
/28Days
TRIKAFTA 50-25-37.5 MG/75 MG TABLET SEQ   5 Specialty Tier 29%N/AP Q:84
/28Days
TRIKAFTA 80-40-60MG/59.5MG GRANULES PACKET SQ   5 Specialty Tier 29%N/AP Q:56
/28Days
TRIMETHOBENZAMIDE 300 MG CAPSULE [Tigan]   4 Non-Preferred Drug 50%50%P
TRIMETHOPRIM 100 MG TABLET [Proloprim]   2 Generic $5.00$15.00None
TRIMIPRAMINE MALEATE 100 MG CAPSULE   4 Non-Preferred Drug 50%50%P Q:60
/30Days
TRIMIPRAMINE MALEATE 25 MG CAPSULE   4 Non-Preferred Drug 50%50%P Q:240
/30Days
TRIMIPRAMINE MALEATE 50 MG CAPSULE   4 Non-Preferred Drug 50%50%P Q:120
/30Days
TRINTELLIX 10 MG TABLET   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRINTELLIX 20 MG TABLET   4 Non-Preferred Drug 50%50%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRINTELLIX 5 MG TABLET   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRIUMEQ PD 60-5-30 MG TABLET SUSP   5 Specialty Tier 29%N/ANone
TRIUMEQ TABLET   5 Specialty Tier 29%N/ANone
TRIVORA-28 TABLET [Trivora]   2 Generic $5.00$15.00None
TRIZIVIR 300; 150; 300mg/1; mg/1; mg/1 60 FILM COATED TABLETS in BOTTLE   5 Specialty Tier 29%N/ANone
TROPHAMINE 10% IV SOLUTION   4 Non-Preferred Drug 50%50%P
TROSPIUM CHLORIDE 20 MG TABLET [Sanctura]   2 Generic $5.00$15.00Q:60
/30Days
TROSPIUM CHLORIDE ER 60 MG CAPSULE 24H [Sanctura XR]   4 Non-Preferred Drug 50%50%Q:30
/30Days
TRULICITY 0.75 MG/0.5 ML PEN   3 Preferred Brand 24%24%P Q:2
/28Days
TRULICITY 1.5 MG/0.5 ML PEN   3 Preferred Brand 24%24%P Q:2
/28Days
TRULICITY 3 MG/0.5 ML PEN INJECTOR   3 Preferred Brand 24%24%P Q:2
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TRULICITY 4.5 MG/0.5 ML PEN INJECTOR   3 Preferred Brand 24%24%P Q:2
/28Days
TRUMENBA 120 MCG/0.5 ML VACCIN Syringe   1* Preferred Generic $0.00$0.00None
TRUQAP 160 MG TABLET   5 Specialty Tier 29%N/AP Q:64
/28Days
TRUQAP 200 MG TABLET   5 Specialty Tier 29%N/AP Q:64
/28Days
TUKYSA 150 MG TABLET   5 Specialty Tier 29%N/AP Q:120
/30Days
TUKYSA 50 MG TABLET   5 Specialty Tier 29%N/AP Q:240
/30Days
TURALIO 125 MG CAPSULE   5 Specialty Tier 29%N/AP Q:120
/30Days
TURQOZ-28 TABLET   2 Generic $5.00$15.00None
TWINRIX VACCINE SYRINGE   1* Preferred Generic $0.00$0.00None
TYBOST 150 MG TABLET   4 Non-Preferred Drug 50%50%None
TYDEMY 3-0.03-0.451 MG TABLET [Tydemy]   2 Generic $5.00$15.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
TYPHIM VI 25 MCG/0.5 ML SYRINGE   1* Preferred Generic $0.00$0.00None
TYPHIM VI 25MCG/0.5ML VIAL   1* Preferred Generic $0.00$0.00None
TYRVAYA 0.03 MG NASAL SPRAY METR   4 Non-Preferred Drug 50%50%Q:8
/30Days

Chart Legend:

Below are a few notes to help you understand the above 2024 Medicare Part D SilverScript SmartSaver (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug or Medicare Advantage plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $545 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.
    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.

  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs.
    • Tier Number* - Some Part D drug plans exclude one or more drug tiers from the plan’s deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.

  • Cost Sharing - Copay / Coinsurance - This is what you will pay for formulary drugs in the Initial Coverage Phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $5,030) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.

      *All forms of insulin covered by any Medicare Part D plan will have a copay of $35 or less through all phases of coverage. Please contact the drug plan for more details.

    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).

  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data March 2024)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Medicare plan provider.







Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.