2025 Medicare Part D Plan Formulary Information |
Blue Cross MedicareRx Value (PDP) (S5715-010-0)
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 Blue Cross MedicareRx Value (PDP) (S5715-010-0) Formulary Drugs Starting with the Letter B in CMS PDP Region 23 which includes: OK
|
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Bacitracin 500 unit/gm Eye Ointment  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT  |
2* |
Generic |
$8.00 | $24.00 | None |
BACLOFEN 10 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BACLOFEN 20 MG TABLET [Lioresal] ![Compare how all Medicare Part D PDP plans in OK cover BACLOFEN 20 MG TABLET [Lioresal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BACLOFEN 5 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal] ![Compare how all Medicare Part D PDP plans in OK cover BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
BALVERSA 3 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
BALVERSA 4 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
BALVERSA 5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BAQSIMI 3 MG SPRAY ONE PACK  |
4 |
Non-Preferred Drug |
47% | 47% | Q:4 /30Days |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE  |
4 |
Non-Preferred Drug |
47% | 47% | None |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BELSOMRA 10 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days |
BELSOMRA 15 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days |
BELSOMRA 20 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days |
BELSOMRA 5 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days |
BENAZEPRIL HCL 10 MG TABLET  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL HCL 20 MG TABLET [Lotensin] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL HCL 20 MG TABLET [Lotensin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL HCL 40 MG TABLET [Lotensin] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL HCL 40 MG TABLET [Lotensin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL HCL 5 MG TABLET  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENAZEPRIL-HCTZ 5-6.25 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in OK cover BENAZEPRIL-HCTZ 5-6.25 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BENLYSTA 200 MG/ML AUTOINJECT  |
5 |
Specialty Tier |
25% | N/A | P |
BENLYSTA 200 MG/ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P |
BENZTROPINE MES 0.5 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in OK cover BENZTROPINE MES 0.5 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | P |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in OK cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | P |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in OK cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | P |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BESREMI 500 MCG/ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAINE 1 GRAM/SCOOP POWDER [Cystadane] ![Compare how all Medicare Part D PDP plans in OK cover BETAINE 1 GRAM/SCOOP POWDER [Cystadane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:135 /30Days |
BETAMETHASONE DP 0.05% LOTION  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:120 /30Days |
BETAMETHASONE DP 0.05% OINTMENT [Maxivate] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE DP 0.05% OINTMENT [Maxivate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:135 /30Days |
BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:200 /28Days |
BETAMETHASONE DP AUG 0.05% GEL  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:200 /28Days |
BETAMETHASONE DP AUG 0.05% LOTION [Diprolene] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE DP AUG 0.05% LOTION [Diprolene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:210 /30Days |
BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:200 /28Days |
BETAMETHASONE VA 0.1% CREAM (G) [Valisone] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE VA 0.1% CREAM (G) [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:135 /30Days |
BETAMETHASONE VALER 0.1% LOTION [Valisone] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE VALER 0.1% LOTION [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:120 /30Days |
BETAMETHASONE VALER 0.1% OINTMENT [Valisone] ![Compare how all Medicare Part D PDP plans in OK cover BETAMETHASONE VALER 0.1% OINTMENT [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:135 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETASERON 0.3 MG KIT  |
5 |
Specialty Tier |
25% | N/A | P Q:15 /30Days |
BETAXOLOL 10 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BETAXOLOL 20 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BETAXOLOL HCL 0.5% EYE DROPS  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BETHANECHOL 10 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BETHANECHOL 25 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BETHANECHOL 5 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BETHANECHOL 50 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BEXAROTENE 1% GEL [Targretin] ![Compare how all Medicare Part D PDP plans in OK cover BEXAROTENE 1% GEL [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in OK cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
BEXSERO PREFILLED SYRINGE  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BICALUTAMIDE 50 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BICILL LA PFS 600MU 1ML PED  |
4 |
Non-Preferred Drug |
47% | 47% | None |
BICILLIN LA PFS 1200MU 2ML  |
4 |
Non-Preferred Drug |
47% | 47% | None |
BICILLIN LA. 600000UNIT/ML 1ML  |
4 |
Non-Preferred Drug |
47% | 47% | None |
BIKTARVY 30-120-15 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
BIKTARVY 50-200-25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
BIMATOPROST 0.03% EYE DROPS [Lumigan] ![Compare how all Medicare Part D PDP plans in OK cover BIMATOPROST 0.03% EYE DROPS [Lumigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:15 /75Days |
BISOPROLOL FUMARATE 10 MG TABLET [Zebeta] ![Compare how all Medicare Part D PDP plans in OK cover BISOPROLOL FUMARATE 10 MG TABLET [Zebeta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BISOPROLOL FUMARATE 5 MG TABLET [Zebeta] ![Compare how all Medicare Part D PDP plans in OK cover BISOPROLOL FUMARATE 5 MG TABLET [Zebeta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BISOPROLOL-HCTZ 10-6.25 MG TABLET [Ziac] ![Compare how all Medicare Part D PDP plans in OK cover BISOPROLOL-HCTZ 10-6.25 MG TABLET [Ziac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BISOPROLOL-HCTZ 2.5-6.25 MG TABLET [Ziac] ![Compare how all Medicare Part D PDP plans in OK cover BISOPROLOL-HCTZ 2.5-6.25 MG TABLET [Ziac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BISOPROLOL-HCTZ 5-6.25 MG TABLET [Ziac] ![Compare how all Medicare Part D PDP plans in OK cover BISOPROLOL-HCTZ 5-6.25 MG TABLET [Ziac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BLISOVI 24 FE TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in OK cover BLISOVI 24 FE TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30] ![Compare how all Medicare Part D PDP plans in OK cover BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BOOSTRIX TDAP VACCINE SYRINGE  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BOOSTRIX TDAP VACCINE VIAL  |
1* |
Preferred Generic |
$1.00 | $3.00 | None |
BOSENTAN 125 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in OK cover BOSENTAN 125 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
BOSENTAN 62.5 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in OK cover BOSENTAN 62.5 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
BOSULIF 100 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
BOSULIF 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
BOSULIF 400 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
BOSULIF 50 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:330 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BOSULIF 500 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
BRAFTOVI 75 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
BREO ELLIPTA 100-25 MCG INH  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
BREO ELLIPTA 200-25 MCG INH  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
BREO ELLIPTA 50-25 MCG INHALER BLST W/DEV  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
BREYNA 160-4.5 MCG INHALER HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in OK cover BREYNA 160-4.5 MCG INHALER HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:10.3 /30Days |
BREYNA 80-4.5 MCG INHALER HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in OK cover BREYNA 80-4.5 MCG INHALER HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:10.3 /30Days |
BREZTRI AEROSPHERE INHALER HFA AER AD  |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:10.7 /30Days |
BRIELLYN TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BRILINTA 60 MG TABLET  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BRILINTA 90mg/1 60 TABLET BOTTLE  |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRIMONIDINE 0.2% EYE DROPS [Alphagan] ![Compare how all Medicare Part D PDP plans in OK cover BRIMONIDINE 0.2% EYE DROPS [Alphagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BRIMONIDINE TARTRATE 0.1% DROPS [Alphagan P] ![Compare how all Medicare Part D PDP plans in OK cover BRIMONIDINE TARTRATE 0.1% DROPS [Alphagan P].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BRIMONIDINE TARTRATE 0.15% DROPS [Alphagan P] ![Compare how all Medicare Part D PDP plans in OK cover BRIMONIDINE TARTRATE 0.15% DROPS [Alphagan P].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BRIMONIDINE-TIMOLOL 0.2%-0.5% DROPS [Combigan] ![Compare how all Medicare Part D PDP plans in OK cover BRIMONIDINE-TIMOLOL 0.2%-0.5% DROPS [Combigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BRINZOLAMIDE 1% EYE DROPS/EYE DROPPER [Azopt] ![Compare how all Medicare Part D PDP plans in OK cover BRINZOLAMIDE 1% EYE DROPS/EYE DROPPER [Azopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
BRIVIACT 10 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
BRIVIACT 10 MG/ML ORAL SOLUTION  |
5 |
Specialty Tier |
25% | N/A | Q:600 /30Days |
BRIVIACT 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
BRIVIACT 25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
BRIVIACT 50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
BRIVIACT 75 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BROMFENAC SODIUM 0.07% EYE DROPS [Prolensa] ![Compare how all Medicare Part D PDP plans in OK cover BROMFENAC SODIUM 0.07% EYE DROPS [Prolensa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in OK cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
BROMOCRIPTINE 5 MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in OK cover BROMOCRIPTINE 5 MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | None |
BRUKINSA 80 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P |
BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | P Q:90 /30Days |
BUDESONIDE ER 9 MG TABLET ER [UCERIS] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE ER 9 MG TABLET ER [UCERIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
BUDESONIDE-FORMOTEROL 160-4.5 HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE-FORMOTEROL 160-4.5 HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:10.3 /30Days |
BUDESONIDE-FORMOTEROL 80-4.5 HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in OK cover BUDESONIDE-FORMOTEROL 80-4.5 HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:10.3 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUMETANIDE 0.5 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in OK cover BUMETANIDE 0.5 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BUMETANIDE 1 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in OK cover BUMETANIDE 1 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BUMETANIDE 1 MG/4 ML VIAL  |
4 |
Non-Preferred Drug |
47% | 47% | None |
BUMETANIDE 2 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in OK cover BUMETANIDE 2 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | None |
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:90 /30Days |
BUPRENORPHINE 2 MG TABLET SUBLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHINE 2 MG TABLET SUBLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:90 /30Days |
BUPRENORPHINE-NALOX 2-0.5MG FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHINE-NALOX 2-0.5MG FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:120 /30Days |
BUPRENORPHINE-NALOX 4-1MG FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHINE-NALOX 4-1MG FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
BUPRENORPHINE-NALOX 8-2MG FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHINE-NALOX 8-2MG FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone] ![Compare how all Medicare Part D PDP plans in OK cover BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:120 /30Days |
BUPROPION HCL 100 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | Q:120 /30Days |
BUPROPION HCL 75 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | Q:60 /30Days |
BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in OK cover BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:90 /30Days |
BUPROPION HCL SR 150 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in OK cover BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:60 /30Days |
BUPROPION HCL SR 200 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in OK cover BUPROPION HCL SR 200 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:60 /30Days |
BUPROPION HCL XL 150 MG TABLET ER 24H [Wellbutrin XL] ![Compare how all Medicare Part D PDP plans in OK cover BUPROPION HCL XL 150 MG TABLET ER 24H [Wellbutrin XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:90 /30Days |
BUPROPION HCL XL 300 MG TABLET ER 24H [Wellbutrin XL] ![Compare how all Medicare Part D PDP plans in OK cover BUPROPION HCL XL 300 MG TABLET ER 24H [Wellbutrin XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $24.00 | Q:30 /30Days |
BUSPIRONE HCL 15 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BUSPIRONE HCL 30 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUSPIRONE HCL 5 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BUSPIRONE HCL 7.5 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLET  |
2* |
Generic |
$8.00 | $24.00 | None |
BUTALB-ACETAMIN-CAFF 50-325-40 TABLET [Repan] ![Compare how all Medicare Part D PDP plans in OK cover BUTALB-ACETAMIN-CAFF 50-325-40 TABLET [Repan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:180 /30Days |
BUTALBITAL-ASA-CAFFEINE CAPSULE [Fiorinal] ![Compare how all Medicare Part D PDP plans in OK cover BUTALBITAL-ASA-CAFFEINE CAPSULE [Fiorinal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:180 /30Days |
BUTORPHANOL 10 MG/ML SPRAY [Stadol NS] ![Compare how all Medicare Part D PDP plans in OK cover BUTORPHANOL 10 MG/ML SPRAY [Stadol NS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
47% | 47% | Q:48 /30Days |
BYDUREON BCISE 2 MG AUTOINJECT  |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:3.4 /28Days |