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2016 Medicare Part D Plan Formulary Information
Humana Enhanced (PDP) (S5552-003-0)
Benefits & Contact Info           
The Humana Enhanced (PDP) (S5552-003-0)
Formulary Drugs Starting with the Letter A

in CMS PDP Region 3 which includes: NY
Plan Monthly Premium: $70.90 Deductible: $0 Qualifies for LIS: No
Drugs Starting with Letter A

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
A-HYDROCORT 100MG VIAL   1 Preferred Generic $3.00$0.00None
ABACAVIR 300 MG TABLET   4 Non-Preferred Brand 44%44%Q:60
/30Days
Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir]   5 Specialty Tier 33%N/AQ:60
/30Days
ABELCENT INJECTION SUSPENSION 5MG/ML   5 Specialty Tier 33%N/ANone
ABILIFY MAINTENA ER 300 MG SYR   5 Specialty Tier 33%N/AQ:2
/28Days
ABILIFY MAINTENA ER 300 MG VL   5 Specialty Tier 33%N/AQ:2
/28Days
ABILIFY MAINTENA ER 400 MG SYR   5 Specialty Tier 33%N/AQ:2
/28Days
ABRAXANE 100MG VIAL   5 Specialty Tier 33%N/AP
Acamprosate Calcium DR 333 MG tablets [Campral]   4 Non-Preferred Brand 44%44%None
ACARBOSE 100 MG TABLET   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACARBOSE 25 MG TABLET   3 Preferred Brand $42.00$116.00None
Acarbose 50mg/1 100 TABLET BOTTLE   3 Preferred Brand $42.00$116.00None
ACEBUTOLOL 200MG CAPSULE   2 Generic $7.00$0.00None
ACEBUTOLOL 400MG CAPSULE   2 Generic $7.00$0.00None
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE   4 Non-Preferred Brand 44%44%None
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD   3 Preferred Brand $42.00$116.00Q:5010
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)   3 Preferred Brand $42.00$116.00Q:390
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)   3 Preferred Brand $42.00$116.00Q:390
/30Days
ACETAMINOPHEN-COD #4 TABLET   3 Preferred Brand $42.00$116.00Q:390
/30Days
ACETASOL HC SOLUTION 10ML 10 ML BOT   4 Non-Preferred Brand 44%44%None
ACETAZOLAMIDE 125MG TABLET   2 Generic $7.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETAZOLAMIDE 250MG TABLET (100 CT)   2 Generic $7.00$0.00None
Acetazolamide 500mg/5mL 1 VIAL in 1 CARTON / 5 mL in 1 VIAL   2 Generic $7.00$0.00None
ACETAZOLAMIDE ER CAPSULES 500MG 100 BOT   4 Non-Preferred Brand 44%44%None
ACETIC ACID 2% SOLUTION NON-ORAL   2 Generic $7.00$0.00None
ACETYLCYSTEINE 10% VIAL   2 Generic $7.00$0.00P
ACETYLCYSTEINE 20% VIAL   2 Generic $7.00$0.00P
ACITRETIN 10 MG CAPSULE [Soriatane]   5 Specialty Tier 33%N/ANone
ACITRETIN 17.5 MG CAPSULE [Soriatane]   5 Specialty Tier 33%N/ANone
ACITRETIN 25 MG CAPSULE [Soriatane]   5 Specialty Tier 33%N/ANone
ACTHIB VACCINE VIAL 10-24UNT/5ML   4 Non-Preferred Brand 44%44%None
ACTIMMUNE 100 MCG/0.5 ML VIAL   5 Specialty Tier 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Acyclovir 200mg 100 CAPSULE BOTTLE   2 Generic $7.00$0.00None
Acyclovir 200mg/5mL 473 mL BOTTLE   4 Non-Preferred Brand 44%44%None
Acyclovir 400mg/1   2 Generic $7.00$0.00None
Acyclovir 5% Ointment   4 Non-Preferred Brand 44%44%P
ACYCLOVIR 800 MG TABLET   2 Generic $7.00$0.00None
Acyclovir sodium 500 mg vial   4 Non-Preferred Brand 44%44%None
ADACEL VIAL 2UNT/5UNT   4 Non-Preferred Brand 44%44%None
ADAGEN 250U/ML VIAL   5 Specialty Tier 33%N/ANone
Adalat CC 30mg 100 FILM COATED TABLETS in BOTTLE   4 Non-Preferred Brand 44%44%Q:60
/30Days
Adalat CC 60mg 1000 FILM COATED TABLETS in BOTTLE   4 Non-Preferred Brand 44%44%Q:60
/30Days
Adalat CC 90mg 100 FILM COATED TABLETS in BOTTLE   4 Non-Preferred Brand 44%44%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]   5 Specialty Tier 33%N/AP Q:2
/28Days
ADAPALENE 0.1% CREAM   4 Non-Preferred Brand 44%44%None
ADAPALENE 0.1% GEL   4 Non-Preferred Brand 44%44%None
ADCIRCA TABLETS 20MG 60 BOTTLE   5 Specialty Tier 33%N/AP Q:60
/30Days
ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera]   5 Specialty Tier 33%N/ANone
ADEMPAS 0.5 MG TABLET   5 Specialty Tier 33%N/AP Q:90
/30Days
ADEMPAS 1 MG TABLET   5 Specialty Tier 33%N/AP Q:90
/30Days
ADEMPAS 1.5 MG TABLET   5 Specialty Tier 33%N/AP Q:90
/30Days
ADEMPAS 2 MG TABLET   5 Specialty Tier 33%N/AP Q:90
/30Days
ADEMPAS 2.5 MG TABLET   5 Specialty Tier 33%N/AP Q:90
/30Days
ADVAIR DISKUS MIS 100/50   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADVAIR DISKUS MIS 250/50   3 Preferred Brand $42.00$116.00None
ADVAIR DISKUS MIS 500/50   3 Preferred Brand $42.00$116.00None
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand $42.00$116.00None
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   3 Preferred Brand $42.00$116.00None
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   3 Preferred Brand $42.00$116.00None
AFEDITAB CR 30MG TABLET SA   3 Preferred Brand $42.00$116.00Q:60
/30Days
AFEDITAB CR 60MG TABLET SA   3 Preferred Brand $42.00$116.00Q:60
/30Days
Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK   5 Specialty Tier 33%N/AP Q:30
/30Days
AFINITOR DISPERZ 2 MG TABLET   5 Specialty Tier 33%N/AP
AFINITOR DISPERZ 3 MG TABLET   5 Specialty Tier 33%N/AP
AFINITOR DISPERZ 5 MG TABLET   5 Specialty Tier 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AFINITOR TABLETS 10 MG   5 Specialty Tier 33%N/AP Q:30
/30Days
AFINITOR TABLETS 2.5 MG   5 Specialty Tier 33%N/AP Q:30
/30Days
AFINITOR TABLETS 5 MG   5 Specialty Tier 33%N/AP Q:30
/30Days
AGGRENOX 25-200MG CAPSULE   4 Non-Preferred Brand 44%44%P
AK-CON 0.1% EYE DROPS   1 Preferred Generic $3.00$0.00None
ALA-CORT 1% CREAM   2 Generic $7.00$0.00None
ALBENZA 200 MG TABLET   5 Specialty Tier 33%N/ANone
ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL   2 Generic $7.00$0.00P
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   2 Generic $7.00$0.00P
ALBUTEROL SULFATE 4MG TABLET SR 12HR   4 Non-Preferred Brand 44%44%None
ALBUTEROL SULFATE 8MG TABLET SR 12HR   4 Non-Preferred Brand 44%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   2 Generic $7.00$0.00P
ALBUTEROL SULFATE SOLUTION FOR INHALATION   2 Generic $7.00$0.00P
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   2 Generic $7.00$0.00None
ALBUTEROL SULFATE TABLET 2MG (500 CT)   4 Non-Preferred Brand 44%44%None
ALBUTEROL TABLET 4MG (500 CT)   4 Non-Preferred Brand 44%44%None
ALCLOMETASONE DIPROPIONATE 0.05% CREAM   3 Preferred Brand $42.00$116.00None
Alclometasone Dipropionate 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE   3 Preferred Brand $42.00$116.00None
ALECENSA 150 MG CAPSULE   5 Specialty Tier 33%N/AP Q:240
/30Days
ALENDRONATE SODIUM 10MG TABLET   1 Preferred Generic $3.00$0.00Q:30
/30Days
ALENDRONATE SODIUM 35 MG TABLET   1 Preferred Generic $3.00$0.00Q:4
/28Days
ALENDRONATE SODIUM 40MG TABLET   1 Preferred Generic $3.00$0.00Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALENDRONATE SODIUM 5MG TABLET   1 Preferred Generic $3.00$0.00Q:30
/30Days
Alendronate Sodium 70mg/1 4 BLISTER PACK in 1 BOX / 1 TABLET in 1 BLISTER PACK   1 Preferred Generic $3.00$0.00Q:4
/28Days
ALFUZOSIN HYDROCHLORIDE 10mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE   2 Generic $7.00$0.00Q:30
/30Days
ALIMTA 500MG VIAL   5 Specialty Tier 33%N/AP
ALINIA 100MG/5ML SUSPENSION   4 Non-Preferred Brand 44%44%Q:150
/30Days
ALINIA 500 MG TABLET   4 Non-Preferred Brand 44%44%Q:40
/30Days
ALKERAN 50 MG VIAL   4 Non-Preferred Brand 44%44%None
ALLOPURINOL 100 MG TABLETS   1 Preferred Generic $3.00$0.00None
Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET per BLISTER PACK   1 Preferred Generic $3.00$0.00None
ALOGLIPTIN 12.5 MG TABLET [Nesina]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN 25 MG TABLET [Nesina]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALOGLIPTIN 6.25 MG TABLET [Nesina]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-METFORMIN 12.5-1000 [Kazano]   4 Non-Preferred Brand 44%44%Q:60
/30Days
ALOGLIPTIN-METFORMIN 12.5-500 [Kazano]   4 Non-Preferred Brand 44%44%Q:60
/30Days
ALOGLIPTIN-PIOGLIT 12.5-15 MG [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-PIOGLIT 12.5-30 MG [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-PIOGLIT 12.5-45 MG [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-PIOGLIT 25-15 MG TABLET [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-PIOGLIT 25-30 MG TABLET [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOGLIPTIN-PIOGLIT 25-45 MG TABLET [Oseni]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ALOMIDE 0.1% EYE DROPS   4 Non-Preferred Brand 44%44%None
ALOPRIM SOLUTION FOR INJECTION 500MG/VIAL 30 ML VIALGL   4 Non-Preferred Brand 44%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALORA 0.025 MG PATCH   4 Non-Preferred Brand 44%44%Q:8
/28Days
ALORA 0.05 MG PATCH   4 Non-Preferred Brand 44%44%Q:8
/28Days
ALORA 0.075 MG PATCH   4 Non-Preferred Brand 44%44%Q:8
/28Days
ALORA 0.1 MG PATCH   4 Non-Preferred Brand 44%44%Q:8
/28Days
ALOSETRON HCL 0.5 MG TABLET [Lotronex]   5 Specialty Tier 33%N/AQ:60
/30Days
ALOSETRON HCL 1 MG TABLET [Lotronex]   5 Specialty Tier 33%N/AQ:60
/30Days
ALPHAGAN P 0.1% DROPS   3 Preferred Brand $42.00$116.00None
ALPHAGAN P 0.15% EYE DROPS   3 Preferred Brand $42.00$116.00None
ALPRAZOLAM 0.25 MG TABLET   2 Generic $7.00$0.00Q:120
/30Days
ALPRAZOLAM 0.5 MG TABLET   2 Generic $7.00$0.00Q:120
/30Days
ALPRAZOLAM 1 MG TABLET   2 Generic $7.00$0.00Q:240
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALPRAZOLAM 2 MG TABLET   2 Generic $7.00$0.00Q:150
/30Days
ALREX 0.2% EYE DROPS   4 Non-Preferred Brand 44%44%None
ALTABAX 10mg/g 30 g in 1 TUBE   4 Non-Preferred Brand 44%44%None
ALVESCO 160MCG/ACT AERS   4 Non-Preferred Brand 44%44%None
ALVESCO 80MCG/ACT AERS   4 Non-Preferred Brand 44%44%None
AMANTADINE 100MG CAPSULE   4 Non-Preferred Brand 44%44%None
AMANTADINE 100MG TABLET   4 Non-Preferred Brand 44%44%None
Amantadine Hydrochloride 50mg/5mL 473 mL in 1 BOTTLE   3 Preferred Brand $42.00$116.00None
AMBISOME 50MG VIAL   4 Non-Preferred Brand 44%44%None
AMCINONIDE 0.1% CREAM   4 Non-Preferred Brand 44%44%None
AMCINONIDE 0.1% LOTION   4 Non-Preferred Brand 44%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMCINONIDE 0.1% OINTMENT 60GM TUBE   4 Non-Preferred Brand 44%44%None
Amethia 2 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK   4 Non-Preferred Brand 44%44%None
Amethyst 20; 90ug/1; ug/1 1 BLISTER PACK per CARTON / 28 TABLET per BLISTER PACK   4 Non-Preferred Brand 44%44%None
AMIFOSTINE 50mg/mL 3 VIAL, SINGLE-USE per CARTON / 10 mL in 1 VIAL, SINGLE-USE   5 Specialty Tier 33%N/ANone
AMIKACIN SULFATE 500 MG/2 ML VIAL   4 Non-Preferred Brand 44%44%None
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET   2 Generic $7.00$0.00None
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT   3 Preferred Brand $42.00$116.00None
Amino Acids 15% Solution   4 Non-Preferred Brand 44%44%P
Aminophylline 25mg/mL 5 TRAY per CARTON / 5 AMPULE in 1 TRAY / 10 mL in 1 AMPULE   2 Generic $7.00$0.00None
AMINOSYN 7%-ELECTROLYTE SOL   4 Non-Preferred Brand 44%44%P
AMINOSYN HBC INJECTION SULFITE FREE 7%   4 Non-Preferred Brand 44%44%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN II 10% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN II 15% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN II 7% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN II 8.5% ELECTROLYT   4 Non-Preferred Brand 44%44%P
AMINOSYN II 8.5% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN M 3.5% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN PF INJECTION   4 Non-Preferred Brand 44%44%P
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   4 Non-Preferred Brand 44%44%P
AMINOSYN-PF 7% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMINOSYN-RF 5.2% IV SOLUTION   4 Non-Preferred Brand 44%44%P
AMIODARONE HCL 200MG 60 TABLET BOTTLE   2 Generic $7.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIODARONE HCL 400MG TABLET   4 Non-Preferred Brand 44%44%None
AMIODARONE HCL 50 MG INJECTION   2 Generic $7.00$0.00None
AMITIZA 8MCG CAPSULE   3 Preferred Brand $42.00$116.00None
AMITIZA CAPSULES 24MCG 60 CAP BOT   3 Preferred Brand $42.00$116.00None
AMITRIP/PERPHEN 10-2 TABLET   3 Preferred Brand $42.00$116.00P
AMITRIP/PERPHEN 10-4 TABLET   3 Preferred Brand $42.00$116.00P
AMITRIP/PERPHEN 25-2 TABLET   3 Preferred Brand $42.00$116.00P
AMITRIP/PERPHEN 25-4 TABLET   3 Preferred Brand $42.00$116.00P
AMITRIP/PERPHEN 50-4 TABLET   3 Preferred Brand $42.00$116.00P
AMITRIPTYLINE HCL 100MG TABLET   1 Preferred Generic $3.00$0.00P
AMITRIPTYLINE HCL 10MG TABLET   1 Preferred Generic $3.00$0.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMITRIPTYLINE HCL 150 MG TAB   1 Preferred Generic $3.00$0.00P
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)   1 Preferred Generic $3.00$0.00P
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)   1 Preferred Generic $3.00$0.00P
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT   1 Preferred Generic $3.00$0.00P
AMLOD-VALSA-HCTZ 10-160-12.5 MG [EXFORGE HCT]   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLOD-VALSA-HCTZ 10-160-25 MG [EXFORGE HCT]   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLOD-VALSA-HCTZ 10-320-25 MG [EXFORGE HCT]   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLOD-VALSA-HCTZ 5-160-12.5 MG [EXFORGE HCT]   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLOD-VALSA-HCTZ 5-160-25 MG [EXFORGE HCT]   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLODIPINE BESYLATE 10MG TABLET (90 CT)   1 Preferred Generic $3.00$0.00None
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)   1 Preferred Generic $3.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMLODIPINE BESYLATE 5MG TABLET (90 CT)   1 Preferred Generic $3.00$0.00None
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE   3 Preferred Brand $42.00$116.00Q:60
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE   3 Preferred Brand $42.00$116.00Q:60
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE   3 Preferred Brand $42.00$116.00Q:60
/30Days
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE   3 Preferred Brand $42.00$116.00Q:60
/30Days
Amlodipine-Atorvastatin 10-10 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 10-20 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 10-40 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 10-80 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 2.5-10 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 2.5-20 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Amlodipine-Atorvastatin 2.5-40 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 5-10 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 5-20 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 5-40 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Amlodipine-Atorvastatin 5-80 mg [Caduet]   4 Non-Preferred Brand 44%44%Q:30
/30Days
AMLODIPINE-BENAZEPRIL 10-40 MG   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLODIPINE-BENAZEPRIL 5-40 MG   3 Preferred Brand $42.00$116.00Q:30
/30Days
AMLODIPINE-VALSARTAN 10-160 MG   4 Non-Preferred Brand 44%44%Q:30
/30Days
AMLODIPINE-VALSARTAN 10-320 MG   4 Non-Preferred Brand 44%44%Q:30
/30Days
AMLODIPINE-VALSARTAN 5-160 MG   4 Non-Preferred Brand 44%44%Q:30
/30Days
AMLODIPINE-VALSARTAN 5-320 MG   4 Non-Preferred Brand 44%44%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMMONIUM CHLORIDE 5 MEQ/ML   2 Generic $7.00$0.00None
AMMONIUM LACTATE 12% CREAM   2 Generic $7.00$0.00None
AMMONIUM LACTATE 12% LOTION   2 Generic $7.00$0.00None
amox tr-k clv 200-28.5/5 susp   2 Generic $7.00$0.00None
AMOX TR-K CLV 500-125 MG TAB   2 Generic $7.00$0.00None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE   2 Generic $7.00$0.00None
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET   2 Generic $7.00$0.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE   2 Generic $7.00$0.00None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL   2 Generic $7.00$0.00None
AMOXAPINE 100MG TABLET   2 Generic $7.00$0.00None
AMOXAPINE 150MG TABLET   2 Generic $7.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXAPINE 25MG TABLET   2 Generic $7.00$0.00None
AMOXAPINE 50MG TABLET   2 Generic $7.00$0.00None
AMOXICILLIN 125MG TABLET CHEW   1 Preferred Generic $3.00$0.00None
AMOXICILLIN 250MG 500 CHEWABLE TABLET in BOTTLE   1 Preferred Generic $3.00$0.00None
AMOXICILLIN 250MG CAPSULE   1 Preferred Generic $3.00$0.00None
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION   2 Generic $7.00$0.00None
AMOXICILLIN 500MG 500 CAPSULE BOTTLE   1 Preferred Generic $3.00$0.00None
AMOXICILLIN 500MG TABLET (100 CT)   1 Preferred Generic $3.00$0.00None
AMOXICILLIN 875MG TABLET   1 Preferred Generic $3.00$0.00None
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT   2 Generic $7.00$0.00None
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT   2 Generic $7.00$0.00None
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT   1 Preferred Generic $3.00$0.00None
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL   1 Preferred Generic $3.00$0.00None
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Preferred Generic $3.00$0.00None
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL   1 Preferred Generic $3.00$0.00None
AMPHETAMINE SALT COMBO 12.5MG TABLET   3 Preferred Brand $42.00$116.00Q:90
/30Days
AMPHETAMINE SALT COMBO 15MG TABLET   3 Preferred Brand $42.00$116.00Q:90
/30Days
AMPHETAMINE SALT COMBO 30MG TABLET   3 Preferred Brand $42.00$116.00Q:60
/30Days
AMPHETAMINE SALT COMBO 7.5MG TABLET   3 Preferred Brand $42.00$116.00Q:90
/30Days
AMPHETAMINE SALTS 20MG TABLET   3 Preferred Brand $42.00$116.00Q:90
/30Days
AMPHETAMINE SALTS 5 MG TAB   3 Preferred Brand $42.00$116.00Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
amphotericin b 50mg/10mL 10 mL in 1 VIAL   4 Non-Preferred Brand 44%44%None
Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS   4 Non-Preferred Brand 44%44%None
AMPICILLIN CAPSULES 250MG 100 BOT   2 Generic $7.00$0.00None
AMPICILLIN CAPSULES 500MG 100 BOT   2 Generic $7.00$0.00None
AMPICILLIN FOR INJECTION POWDER   4 Non-Preferred Brand 44%44%None
AMPICILLIN FOR ORAL SUSPENSION 125MG 100ML BOT   2 Generic $7.00$0.00None
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT   2 Generic $7.00$0.00None
AMPICILLIN POWDER FOR INJECTION 1 GM/ML   4 Non-Preferred Brand 44%44%None
AMPICILLIN-SULBACTAM 15 GM VIAL   4 Non-Preferred Brand 44%44%None
AMPICILLIN-SULBACTAM 3 GM VIAL   4 Non-Preferred Brand 44%44%None
AMPICILLIN-SULBACTAM FOR INJECTION   4 Non-Preferred Brand 44%44%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPYRA ER 10 MG TABLET   5 Specialty Tier 33%N/AP Q:60
/30Days
ANADROL-50 TABLET   5 Specialty Tier 33%N/ANone
Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE   3 Preferred Brand $42.00$116.00None
Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE   3 Preferred Brand $42.00$116.00None
Anastrozole 1mg/1 90 FILM COATED TABLETS in BOTTLE, PLASTIC   1 Preferred Generic $3.00$0.00Q:30
/30Days
ANCOBON 250MG CAPSULE   4 Non-Preferred Brand 44%44%None
ANCOBON 500MG CAPSULE   4 Non-Preferred Brand 44%44%None
ANDROGEL 1.62% (1.25G) GEL PCKT   3 Preferred Brand $42.00$116.00Q:38
/30Days
ANDROGEL 1.62% (2.5G) GEL PCKT   3 Preferred Brand $42.00$116.00Q:150
/30Days
Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP   3 Preferred Brand $42.00$116.00None
ANORO ELLIPTA 62.5-25 MCG INH   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ANUSOL-HC 2.5% CREAM   4 Non-Preferred Brand 44%44%None
Apexicon E 0.05% Cream   4 Non-Preferred Brand 44%44%None
APIDRA 100 UNITS/ML VIAL   4 Non-Preferred Brand 44%44%None
APIDRA SOLOSTAR 100 UNITS/ML   4 Non-Preferred Brand 44%44%None
APOKYN 30 MG/3 ML CARTRIDGE   5 Specialty Tier 33%N/AQ:60
/28Days
Apraclonidine Ophthalmic 5mg/mL 1 BOTTLE, DROPPER per CARTON / 10 mL in 1 BOTTLE, DROPPER   4 Non-Preferred Brand 44%44%None
APRI 0.15-0.03 TABLET   4 Non-Preferred Brand 44%44%None
APRISO CP24   3 Preferred Brand $42.00$116.00Q:120
/30Days
APTIOM 200 MG TABLET   4 Non-Preferred Brand 44%44%P Q:30
/30Days
APTIOM 400 MG TABLET   4 Non-Preferred Brand 44%44%P Q:30
/30Days
APTIOM 600 MG TABLET   4 Non-Preferred Brand 44%44%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
APTIOM 800 MG TABLET   4 Non-Preferred Brand 44%44%P Q:30
/30Days
APTIVUS 250MG CAPSULE   5 Specialty Tier 33%N/AQ:120
/30Days
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   5 Specialty Tier 33%N/AQ:285
/28Days
ARALAST NP 500 MG VIAL   5 Specialty Tier 33%N/AP
ARANELLE 7-9-5 TABLET   4 Non-Preferred Brand 44%44%None
ARCALYST INJECTION 220MG/VIAL   5 Specialty Tier 33%N/AP
Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE 10 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE 15 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE 2 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE 20 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARIPIPRAZOLE 30 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE 5 MG TABLET [Abilify]   4 Non-Preferred Brand 44%44%Q:30
/30Days
ARIPIPRAZOLE ODT 10 MG TABLET [Abilify]   5 Specialty Tier 33%N/AQ:60
/30Days
ARIPIPRAZOLE ODT 15 MG TABLET [Abilify]   5 Specialty Tier 33%N/AQ:60
/30Days
ARRANON 250MG VIAL   5 Specialty Tier 33%N/ANone
Ashlyna 0.15-0.03-0.01 mg tablet   4 Non-Preferred Brand 44%44%None
ASMANEX HFA 100 MCG INHALER   3 Preferred Brand $42.00$116.00None
ASMANEX HFA 200 MCG INHALER   3 Preferred Brand $42.00$116.00None
ASMANEX TWISTHALER 110 MCG #30   3 Preferred Brand $42.00$116.00None
ASMANEX TWISTHALER 220 MCG #30   3 Preferred Brand $42.00$116.00None
ASMANEX TWISTHALER 220MCG #120   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ASMANEX TWISTHALER 220MCG #60   3 Preferred Brand $42.00$116.00None
ASPIRIN-DIPYRIDAM ER 25-200 MG [Aggrenox]   4 Non-Preferred Brand 44%44%None
Atelvia 35mg/1 36 DOSE PACK CASE / 4 TABLET, DELAYED RELEASE in 1 DOSE PACK   4 Non-Preferred Brand 44%44%None
ATENOLOL 100 MG100 TABLET BOTTLE   1 Preferred Generic $3.00$0.00None
ATENOLOL 25 MG 100 TABLET BOTTLE   1 Preferred Generic $3.00$0.00None
ATENOLOL TABLET USP 50MG (100 CT)   1 Preferred Generic $3.00$0.00None
ATENOLOL-CHLORTHALIDONE 100-25   2 Generic $7.00$0.00None
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   2 Generic $7.00$0.00None
ATGAM 50MG/ML AMPUL   3 Preferred Brand $42.00$116.00P
ATORVASTATIN 10 MG TABLET [Lipitor]   2 Generic $7.00$0.00Q:30
/30Days
ATORVASTATIN 20 MG TABLET [Lipitor]   2 Generic $7.00$0.00Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATORVASTATIN 40 MG TABLET [Lipitor]   2 Generic $7.00$0.00Q:30
/30Days
ATORVASTATIN 80 MG TABLET [Lipitor]   2 Generic $7.00$0.00Q:30
/30Days
ATOVAQUONE 750 MG/5 ML SUSP [Mepron]   5 Specialty Tier 33%N/ANone
Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone]   4 Non-Preferred Brand 44%44%None
Atovaquone-Proguanil 62.5-25 [Malarone]   4 Non-Preferred Brand 44%44%None
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC   5 Specialty Tier 33%N/AQ:30
/30Days
ATROPINE 0.05MG/ML SYRINGE   2 Generic $7.00$0.00None
ATROPINE 0.1MG/ML SYRINGE   2 Generic $7.00$0.00None
Atropine 1% Eye Drops   2 Generic $7.00$0.00None
ATROVENT HFA AER 17MCG   4 Non-Preferred Brand 44%44%None
AUBAGIO 14 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AUBAGIO 7 MG TABLET   5 Specialty Tier 33%N/AP Q:30
/30Days
AUBRA-28 TABLET   4 Non-Preferred Brand 44%44%None
AVANDIA 2 MG TABLET   4 Non-Preferred Brand 44%44%Q:60
/30Days
AVANDIA 4 MG TABLET   4 Non-Preferred Brand 44%44%Q:60
/30Days
AVASTIN 100MG/4ML VIAL   5 Specialty Tier 33%N/AP
AVASTIN 400 MG/16 ML VIAL   5 Specialty Tier 33%N/AP
AVC 15% CREAM   2 Generic $7.00$0.00None
AVIANE 0.1-0.02 TABLET   4 Non-Preferred Brand 44%44%None
AVODART 0.5MG SOFTGEL   4 Non-Preferred Brand 44%44%P Q:30
/30Days
AVONEX ADMIN PACK 30 MCG VL   5 Specialty Tier 33%N/AP Q:4
/28Days
AVONEX PEN 30 MCG/0.5 ML KIT   5 Specialty Tier 33%N/AP Q:2
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVONEX PREFILLED SYR 30 MCG KT   5 Specialty Tier 33%N/AP Q:2
/28Days
Aygestin 5mg/1 50 TABLET BOTTLE   4 Non-Preferred Brand 44%44%None
Azacitidine 100 mg vial [Vidaza]   5 Specialty Tier 33%N/AP
AZASAN 100MG TABLET   4 Non-Preferred Brand 44%44%P
AZASAN 75MG TABLET   4 Non-Preferred Brand 44%44%P
AZASITE 1% EYE DROPS   3 Preferred Brand $42.00$116.00None
AZATHIOPRINE 50 MG TABLET   2 Generic $7.00$0.00P
AZATHIOPRINE SODIUM 100 MG VIAL   4 Non-Preferred Brand 44%44%P
AZELASTINE 0.15% NASAL SPRAY   4 Non-Preferred Brand 44%44%Q:30
/25Days
AZELASTINE 137 MCG NASAL SPRAY   3 Preferred Brand $42.00$116.00Q:30
/25Days
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION   3 Preferred Brand $42.00$116.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZELEX 20% CREAM 30GM TUBE   4 Non-Preferred Brand 44%44%None
AZILECT 0.5MG TABLET   3 Preferred Brand $42.00$116.00None
AZILECT 1MG TABLET   3 Preferred Brand $42.00$116.00None
AZITHROMYCIN 1 GM PWD PACKET   3 Preferred Brand $42.00$116.00None
AZITHROMYCIN 100 MG/5 ML SUSP   3 Preferred Brand $42.00$116.00None
Azithromycin 200mg/5mL 22.5 mL in 1 BOTTLE   3 Preferred Brand $42.00$116.00None
AZITHROMYCIN 250 MG TABLET   2 Generic $7.00$0.00None
AZITHROMYCIN 250 MG TABLET   2 Generic $7.00$0.00None
Azithromycin 500mg/1 10 VIAL, SINGLE-USE in 1 TRAY / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION   3 Preferred Brand $42.00$116.00None
Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE   2 Generic $7.00$0.00None
Azithromycin 600mg/1 30 FILM COATED TABLETS in BOTTLE   2 Generic $7.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Azithromycin i.v. 500 mg vial   3 Preferred Brand $42.00$116.00None
AZOPT SUSPENSION OPHTHALMIC 1% 15ML BOT   3 Preferred Brand $42.00$116.00None
AZOR 10MG-20MG TABLET   3 Preferred Brand $42.00$116.00Q:30
/30Days
AZOR 10MG-40MG TABLET (30 CT)   3 Preferred Brand $42.00$116.00Q:30
/30Days
AZOR 5MG-20MG TABLET (30 CT)   3 Preferred Brand $42.00$116.00Q:30
/30Days
AZOR 5MG-40MG TABLET   3 Preferred Brand $42.00$116.00Q:30
/30Days
AZTREONAM FOR INJECTION   4 Non-Preferred Brand 44%44%None
AZULFIDINE 500MG TABLET   4 Non-Preferred Brand 44%44%None


Chart Legend:

What does all this mean? Below are a few notes to help you understand the above 2016 Medicare Part D Humana Enhanced (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug 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).

  • 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 the standard $360 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 wit 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 four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to 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 which tier the drug is in. 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 intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3310) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2016 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • 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 August 2016 )

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 Part D plan provider.