2025 Medicare Part D Plan Formulary Information |
Anthem MediBlue Rx Standard (PDP) (S5596-046-0)
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 Anthem MediBlue Rx Standard (PDP) (S5596-046-0) Formulary Drugs Starting with the Letter P in CMS PDP Region 01 which includes: ME NH
|
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 100MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PACERONE 200 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PACERONE 400 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PALIPERIDONE ER 1.5 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in ME cover PALIPERIDONE ER 1.5 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
PALIPERIDONE ER 3 MG TABLET 24H [Invega] ![Compare how all Medicare Part D PDP plans in ME cover PALIPERIDONE ER 3 MG TABLET 24H [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
PALIPERIDONE ER 6 MG TABLET 24H [Invega] ![Compare how all Medicare Part D PDP plans in ME cover PALIPERIDONE ER 6 MG TABLET 24H [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
PALIPERIDONE ER 9 MG TABLET 24 [Invega] ![Compare how all Medicare Part D PDP plans in ME cover PALIPERIDONE ER 9 MG TABLET 24 [Invega].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
PANRETIN 0.1% GEL  |
5 |
Specialty Tier |
25% | N/A | None |
PANTOPRAZOLE SOD DR 20 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PANTOPRAZOLE SOD DR 40 MG TABLET DR [Protonix] ![Compare how all Medicare Part D PDP plans in ME cover PANTOPRAZOLE SOD DR 40 MG TABLET DR [Protonix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PARICALCITOL 1 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in ME cover PARICALCITOL 1 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PARICALCITOL 2 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in ME cover PARICALCITOL 2 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PARICALCITOL 4 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in ME cover PARICALCITOL 4 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PAROXETINE HCL 10 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | Q:45 /30Days |
PAROXETINE HCL 10 MG/5 ML ORAL SUSPENSION [Paxil] ![Compare how all Medicare Part D PDP plans in ME cover PAROXETINE HCL 10 MG/5 ML ORAL SUSPENSION [Paxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:900 /30Days |
PAROXETINE HCL 20 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | Q:30 /30Days |
PAROXETINE HCL 30 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | Q:60 /30Days |
PAROXETINE HCL 40 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | Q:45 /30Days |
Paxlovid 150 mg / 100 mg 20 Tablet Blister Pack  |
3 |
Preferred Brand |
17% | 17% | Q:20 /90Days |
Paxlovid 300 mg / 100 mg 30 Tablet Blister Pack  |
3 |
Preferred Brand |
17% | 17% | Q:30 /90Days |
PAZOPANIB HCL 200 MG TABLET [Votrient] ![Compare how all Medicare Part D PDP plans in ME cover PAZOPANIB HCL 200 MG TABLET [Votrient].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PEDVAXHIB VACCINE VIAL  |
3 |
Preferred Brand |
17% | 17% | None |
PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte] ![Compare how all Medicare Part D PDP plans in ME cover PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PEG-3350 AND ELECTROLYTES SOLUTION SOLUTION RECON  |
2 |
Generic |
$4.00 | $12.00 | None |
PEGASYS 180 MCG/0.5 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | None |
PEGASYS 180 MCG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
PEMAZYRE 13.5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PEMAZYRE 4.5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PEMAZYRE 9 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PENBRAYA Prefilled Syringe  |
3 |
Preferred Brand |
17% | 17% | None |
PENICILLAMINE 250 MG TABLET [Depen] ![Compare how all Medicare Part D PDP plans in ME cover PENICILLAMINE 250 MG TABLET [Depen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in ME cover Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENICILLIN GK 20 MILLION UNIT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID  |
2 |
Generic |
$4.00 | $12.00 | None |
PENICILLIN VK 125 MG/5 ML SOLUTION  |
2 |
Generic |
$4.00 | $12.00 | None |
PENICILLIN VK 250 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PENICILLIN VK 500 MG TABLET [Veetids] ![Compare how all Medicare Part D PDP plans in ME cover PENICILLIN VK 500 MG TABLET [Veetids].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PENTACEL VIAL KIT  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent] ![Compare how all Medicare Part D PDP plans in ME cover PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PENTAMIDINE 300 MG VIAL [Pentam] ![Compare how all Medicare Part D PDP plans in ME cover PENTAMIDINE 300 MG VIAL [Pentam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PENTOXIFYLLINE 400MG TABLET SA  |
2 |
Generic |
$4.00 | $12.00 | None |
PERINDOPRIL ERBUMINE 2 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PERINDOPRIL ERBUMINE 4 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERINDOPRIL ERBUMINE 8 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PERIOGARD 0.12% ORAL RINSE MOUTHWASH [Perisol] ![Compare how all Medicare Part D PDP plans in ME cover PERIOGARD 0.12% ORAL RINSE MOUTHWASH [Perisol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PERMETHRIN 5% CREAM (G) [Elimite] ![Compare how all Medicare Part D PDP plans in ME cover PERMETHRIN 5% CREAM (G) [Elimite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PERPHEN-AMITRIP 2 MG-10 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PERPHEN-AMITRIP 2 MG-25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PERPHEN-AMITRIP 4 MG-25 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PERPHENAZINE 16 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in ME cover PERPHENAZINE 16 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHENAZINE 2 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in ME cover PERPHENAZINE 2 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHENAZINE 4 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in ME cover PERPHENAZINE 4 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERPHENAZINE 8 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in ME cover PERPHENAZINE 8 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT  |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT  |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /28Days |
PHENELZINE SULFATE 15 MG TABLET [Nardil] ![Compare how all Medicare Part D PDP plans in ME cover PHENELZINE SULFATE 15 MG TABLET [Nardil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
Phenobarbital 100mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
PHENOBARBITAL 15 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
PHENOBARBITAL 16.2 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:210 /30Days |
PHENOBARBITAL 20 MG/5 ML SOLUTION ELIXIR  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:3000 /30Days |
PHENOBARBITAL 30 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
PHENOBARBITAL 32.4 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:210 /30Days |
Phenobarbital 60mg/1  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
PHENOBARBITAL 64.8 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
PHENOBARBITAL 97.2 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHENYTEK 300 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | P |
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin] ![Compare how all Medicare Part D PDP plans in ME cover PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin] ![Compare how all Medicare Part D PDP plans in ME cover PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PHENYTOIN SOD EXT 100 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PHENYTOIN SOD EXT 200 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek] ![Compare how all Medicare Part D PDP plans in ME cover PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PIFELTRO 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
PILOCARPINE 1% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in ME cover PILOCARPINE 1% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PILOCARPINE 2% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in ME cover PILOCARPINE 2% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PILOCARPINE 4% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in ME cover PILOCARPINE 4% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PILOCARPINE HCL 5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in ME cover PILOCARPINE HCL 5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PILOCARPINE HCL 7.5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in ME cover PILOCARPINE HCL 7.5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMECROLIMUS 1% CREAM (g) [Elidel] ![Compare how all Medicare Part D PDP plans in ME cover PIMECROLIMUS 1% CREAM (g) [Elidel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:100 /30Days |
PIMOZIDE 1 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in ME cover PIMOZIDE 1 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMOZIDE 2 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in ME cover PIMOZIDE 2 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIMTREA 28 DAY TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PINDOLOL 10 MG TABLET [Visken] ![Compare how all Medicare Part D PDP plans in ME cover PINDOLOL 10 MG TABLET [Visken].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PINDOLOL 5 MG TABLET [Visken] ![Compare how all Medicare Part D PDP plans in ME cover PINDOLOL 5 MG TABLET [Visken].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIOGLITAZONE HCL 15 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in ME cover PIOGLITAZONE HCL 15 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:90 /30Days |
PIOGLITAZONE HCL 30 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in ME cover PIOGLITAZONE HCL 30 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:45 /30Days |
PIOGLITAZONE HCL 45 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in ME cover PIOGLITAZONE HCL 45 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn Powder] ![Compare how all Medicare Part D PDP plans in ME cover PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in ME cover PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIPERACIL-TAZOBACT 4.5 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in ME cover PIPERACIL-TAZOBACT 4.5 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn Powder] ![Compare how all Medicare Part D PDP plans in ME cover PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PIQRAY 200 MG DAILY DOSE TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
PIQRAY 250 MG DAILY DOSE TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
PIQRAY 300 MG DAILY DOSE TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
PIRFENIDONE 267 MG TABLET [ESBRIET] ![Compare how all Medicare Part D PDP plans in ME cover PIRFENIDONE 267 MG TABLET [ESBRIET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
PIRFENIDONE 534 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
PIRFENIDONE 801 MG TABLET [ESBRIET] ![Compare how all Medicare Part D PDP plans in ME cover PIRFENIDONE 801 MG TABLET [ESBRIET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
PODOFILOX 0.5% TOPICAL SOLUTION [Condylox] ![Compare how all Medicare Part D PDP plans in ME cover PODOFILOX 0.5% TOPICAL SOLUTION [Condylox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POLYCIN EYE OINTMENT [Polytracin] ![Compare how all Medicare Part D PDP plans in ME cover POLYCIN EYE OINTMENT [Polytracin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POLYMYXIN B-TMP EYE DROPS  |
2 |
Generic |
$4.00 | $12.00 | None |
POMALYST 1 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 2 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 3 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
POMALYST 4 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
PORTIA 0.15-0.03 TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
POSACONAZOLE DR 100 MG TABLET [Noxafil] ![Compare how all Medicare Part D PDP plans in ME cover POSACONAZOLE DR 100 MG TABLET [Noxafil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
POTASSIUM CITRATE ER 10 MEQ TB  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 15 MEQ TABLET [Urocit-K] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CITRATE ER 15 MEQ TABLET [Urocit-K].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CITRATE ER 5 MEQ TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL 10% (20 MEQ/15ML) LIQUID [Kay Ciel] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL 10% (20 MEQ/15ML) LIQUID [Kay Ciel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ-0.45% NACL IV SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ/1,000ML-NS IV SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK  |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 20% (40 MEQ/15ML) LIQUID [Kaon-CL] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL 20% (40 MEQ/15ML) LIQUID [Kaon-CL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL 60 MEQ/30 ML CONC VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL 60 MEQ/30 ML CONC VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
POTASSIUM CL ER 10 MEQ CAPSULE ER [Micro-K Extencaps] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 10 MEQ CAPSULE ER [Micro-K Extencaps].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 10 MEQ TABLET [Klotrix] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 10 MEQ TABLET [Klotrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 10 MEQ TABLET PRT [Klotrix] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 10 MEQ TABLET PRT [Klotrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 15 MEQ TABLET ER PRT [Klor-Con M15] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 15 MEQ TABLET ER PRT [Klor-Con M15].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL ER 20 MEQ TABLET [K-Tab] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 20 MEQ TABLET [K-Tab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 20 MEQ TABLET PRT [Klor-Con M20] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 20 MEQ TABLET PRT [Klor-Con M20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
POTASSIUM CL ER 8 MEQ TABLET [Slow-K] ![Compare how all Medicare Part D PDP plans in ME cover POTASSIUM CL ER 8 MEQ TABLET [Slow-K].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 0.125 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in ME cover PRAMIPEXOLE 0.125 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 0.25 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in ME cover PRAMIPEXOLE 0.25 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 0.5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 0.75 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 1 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in ME cover PRAMIPEXOLE 1 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAMIPEXOLE 1.5 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in ME cover PRAMIPEXOLE 1.5 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAVASTATIN SODIUM 10 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in ME cover PRAVASTATIN SODIUM 10 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAVASTATIN SODIUM 20 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
PRAVASTATIN SODIUM 40 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in ME cover PRAVASTATIN SODIUM 40 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
PRAVASTATIN SODIUM 80 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in ME cover PRAVASTATIN SODIUM 80 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
PRAZIQUANTEL 600 MG TABLET [Biltricide] ![Compare how all Medicare Part D PDP plans in ME cover PRAZIQUANTEL 600 MG TABLET [Biltricide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRAZOSIN 1 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in ME cover PRAZOSIN 1 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAZOSIN 2 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in ME cover PRAZOSIN 2 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRAZOSIN 5 MG CAPSULE [Minipress] ![Compare how all Medicare Part D PDP plans in ME cover PRAZOSIN 5 MG CAPSULE [Minipress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISOLONE 15 MG/5 ML SOLUTION [Prelone] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISOLONE 15 MG/5 ML SOLUTION [Prelone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISOLONE 5 MG/5 ML SOLUTION [Pediapred] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISOLONE 5 MG/5 ML SOLUTION [Pediapred].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREDNISOLONE AC 1% EYE DROPPER [Pred-Forte] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISOLONE AC 1% EYE DROPPER [Pred-Forte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISOLONE SOD PH 25 MG/5 ML SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISONE 1 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 10 MG TABLET [Sterapred DS] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISONE 10 MG TABLET [Sterapred DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 2.5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 20 MG TABLET [Predone] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISONE 20 MG TABLET [Predone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 5 MG TABLET [Sterapred] ![Compare how all Medicare Part D PDP plans in ME cover PREDNISONE 5 MG TABLET [Sterapred].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PREDNISONE 5 MG/5 ML SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREDNISONE 50MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISONE 5MG/ML SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREGABALIN 100 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 100 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
PREGABALIN 150 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 150 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
PREGABALIN 20 MG/ML SOLUTION [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 20 MG/ML SOLUTION [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:900 /30Days |
PREGABALIN 200 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 200 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | Q:90 /30Days |
PREGABALIN 225 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 225 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | Q:60 /30Days |
PREGABALIN 25 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 25 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
PREGABALIN 300 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 300 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | Q:60 /30Days |
PREGABALIN 50 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 50 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
PREGABALIN 75 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in ME cover PREGABALIN 75 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
17% | 17% | None |
PREHEVBRIO 10 MCG/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMASOL 10% IV SOLUTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PREVALITE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PREVYMIS 240 MG  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PREVYMIS 480 MG  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PREZCOBIX 800 MG-150 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
PREZISTA 100 MG/ML SUSPENSION  |
5 |
Specialty Tier |
25% | N/A | Q:400 /30Days |
PREZISTA 150MG TABLETS  |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days |
PREZISTA TABLET 75MG  |
4 |
Non-Preferred Drug |
50% | 50% | Q:300 /30Days |
PRIFTIN 150 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PRIMAQUINE 26.3 MG TABLET [Primaquine] ![Compare how all Medicare Part D PDP plans in ME cover PRIMAQUINE 26.3 MG TABLET [Primaquine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRIMIDONE 125 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRIMIDONE 250 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in ME cover PRIMIDONE 250 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRIMIDONE 50 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in ME cover PRIMIDONE 50 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PRIORIX VIAL  |
3 |
Preferred Brand |
17% | 17% | None |
PROBENECID 500 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROBENECID-COLCHICINE TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROCHLORPERAZINE 10 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROCHLORPERAZINE 5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROCRIT 10000U/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 3,000 UNITS/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCRIT 4,000 UNITS/ML VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROCRIT 40000U/ML VIAL PR  |
5 |
Specialty Tier |
25% | N/A | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY  |
5 |
Specialty Tier |
25% | N/A | P |
PROCTO-MED HC 2.5% CREAM /PE APP [Proctozone-HC] ![Compare how all Medicare Part D PDP plans in ME cover PROCTO-MED HC 2.5% CREAM /PE APP [Proctozone-HC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROCTOSOL-HC 2.5% CREAM  |
2 |
Generic |
$4.00 | $12.00 | None |
PROCTOZONE-HC 2.5% CREAM  |
2 |
Generic |
$4.00 | $12.00 | None |
PROGRAF 0.2 MG GRANULE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROGRAF 1 MG GRANULE PACKET  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROLASTIN C 1,000 MG/20 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
PROLIA 60MG/ML INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | P Q:1 /180Days |
PROMACTA 12.5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMACTA 25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
PROMACTA 50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
PROMACTA 75 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
PROMETHAZINE 12.5 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROMETHAZINE 25 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROMETHAZINE 50 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain] ![Compare how all Medicare Part D PDP plans in ME cover PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROPAFENONE HCL 150 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in ME cover PROPAFENONE HCL 150 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPAFENONE HCL 225 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in ME cover PROPAFENONE HCL 225 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPAFENONE HCL 300 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in ME cover PROPAFENONE HCL 300 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 10 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL 20 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in ME cover PROPRANOLOL 20 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 20MG/5ML TUBEX  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 40 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in ME cover PROPRANOLOL 40 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 40MG/5ML TUBEX  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 60 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL 80 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in ME cover PROPRANOLOL 80 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL ER 120 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL ER 160 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL ER 60 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPRANOLOL ER 80 MG CAPSULE  |
2 |
Generic |
$4.00 | $12.00 | None |
PROPYLTHIOURACIL 50 MG TABLET  |
2 |
Generic |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROQUAD VIAL  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PROSOL 20% INJECTION  |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROTRIPTYLINE HCL 10 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in ME cover PROTRIPTYLINE HCL 10 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PROTRIPTYLINE HCL 5 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in ME cover PROTRIPTYLINE HCL 5 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
PULMOZYME 1MG/ML AMPUL  |
5 |
Specialty Tier |
25% | N/A | P |
PURIXAN 20 MG/ML ORAL SUSPENSION  |
5 |
Specialty Tier |
25% | N/A | P |
PYRAZINAMIDE 500 MG TABLET  |
4 |
Non-Preferred Drug |
50% | 50% | None |
PYRIDOSTIGMINE BR 60 MG TABLET  |
3 |
Preferred Brand |
17% | 17% | None |
PYRIMETHAMINE 25 MG TABLET [Daraprim] ![Compare how all Medicare Part D PDP plans in ME cover PYRIMETHAMINE 25 MG TABLET [Daraprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |