2015 Humana Preferred Rx Plan (PDP) Drug Coverage Details



Below is the Formulary, or drug list, for Humana Preferred Rx Plan (PDP) from Humana Insurance Company This formulary is a list of prescription medications that are covered under Humana Insurance Company's 2015 Part-D Plan. The Humana Preferred Rx Plan (PDP) plan has a $320 drug deductible. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. However some drugs do not require that the deductible is met before you receive coverage. You can see if the deductible is required below in the "Does the Deductible Apply" column. The Initial Coverage Limit (ICL) for this plan is $2960. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $2960 on covered drugs. (combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" be clicking the "Coverage Gap" link on the left above the chart. In 2015 if you have spent $4700 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Humana Preferred Rx Plan (PDP) will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link on the left above the chart.





Plan Name:
Humana Preferred Rx Plan (PDP)
Plan ID:
S5884-110
Provider: Humana Insurance Company
Plan Year:2015
Premium:$20.20
Deductible:$320
Initial Coverage Limit:$2960
Coverage Area:New Mexico






Current Table info:


Coverage level : Initial Coverage
Days Supply : 30 Days
Drugs Starting With Letter: C



Change Table Options:


Drugs Starting Letter:
A  B  C  D  E  F  G  H  I  J  K  L  M 
N  O  P  Q  R  S  T  U  V  W  X  Y  Z 

Coverage Level:
Pre-deductible,Initial Coverage
Coverage Gap, Catastrophic

Drug Days Pricing:
30 Day Supply, 60 Day Supply, 90 Day Supply

(Mouse over for Tips)
(Click the Drug Name to Compare every Plans Price)

Drug Name Drug Strength Units in Package Tier Level Amount Limit Days Limit Prior Authorization Y/N Step Therapy Y/N Does the Deduct Apply Cost Prefered Max Cost Pref Cost Non Pref Max Cost Non Pref Cost Amt Mail Max Cost Mail
Calcipotriene .05mg/mL 60 Ml In 1 Bottle, Plastic
4
60 30 N N Y 35%None41%None35%None
Calcipotriene .05mg/g 1 Tube In 1 Carton > 120 G In 1 Tube
4
120 30 N N Y 35%None41%None35%None
Calcipotriene .05mg/g 1 Tube In 1 Carton > 60 G In 1 Tube
4
N N N N Y 35%None41%None35%None
Calcitonin Salmon 200[iU] 1 Bottle, Glass In 1 Carton > 30 Spray, Metered In 1 Bottle, Glass
3
4 28 N N Y 20%None25%None20%None
Calcitriol .25ug 100 Capsule In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Calcitriol 1ug/mL 1 Bottle, With Applicator In 1 Carton > 15 Ml In 1 Bottle, With Applicator
3
N N N N Y 20%None25%None20%None
Calcitriol .5ug 100 Capsule, Liquid Filled In 1 Bottle
3
N N N N Y 20%None25%None20%None
Calcitriol 1ug/mL 25 Ampule In 1 Carton > 1 Ml In 1 Ampule
3
N N N N Y 20%None25%None20%None
Calcium Acetate 667mg 200 Capsule In 1 Bottle
4
N N N N Y 35%None41%None35%None
Camila .35mg 6 Blister Pack In 1 Carton > 28 Tablet In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Canasa 1000mg 30 Suppository In 1 Box
3
30 30 N N Y 20%None25%None20%None
Cancidas 5mg/mL 1 Vial, Single-use In 1 Carton > 10.8 Ml In 1 Vial, Single-use
5
N N N N Y 25%None25%None25%None
Cancidas 7mg/mL 1 Vial, Single-use In 1 Carton > 10.8 Ml In 1 Vial, Single-use
5
N N N N Y 25%None25%None25%None
Candesartan Cilexetil 4mg 30 Tablet In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Candesartan Cilexetil 8mg 30 Tablet In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Candesartan Cilexetil 16mg 90 Tablet In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Candesartan Cilexetil 32mg 90 Tablet In 1 Bottle
3
30 30 N N Y 20%None25%None20%None
Candesartan Cilexetil And Hydrochlorothiazide 16; 12.5mg/1; mg 90 Tablet In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Candesartan Cilexetil And Hydrochlorothiazide 32; 12.5mg/1; mg 90 Tablet In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Candesartan Cilexetil And Hydrochlorothiazide 32; 25mg/1; mg 90 Tablet In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Capastat Sulfate 1g 1 Injection, Powder, For Solution In 1 Carton
4
N N N N Y 35%None41%None35%None
Capital And Codeine 120; 12mg/5mL; mg/5mL 473 Ml In 1 Bottle
4
5010 30 N N Y 35%None41%None35%None
Caprelsa 100mg 30 Tablet In 1 Bottle, Plastic
5
60 30 Y N Y 25%None25%None25%None
Caprelsa 300mg 30 Tablet In 1 Bottle, Plastic
5
30 30 Y N Y 25%None25%None25%None
Captopril 12.5mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril 25mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril 50mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril 100mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril And Hydrochlorothiazide 25; 15mg/1; mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril And Hydrochlorothiazide 25; 25mg/1; mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril And Hydrochlorothiazide 50; 15mg/1; mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Captopril And Hydrochlorothiazide 50; 25mg/1; mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Carbaglu 200mg 5 Tablet In 1 Bottle
5
N N Y N Y 25%None25%None25%None
Carbamazepine 200mg 1000 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Carbamazepine 100mg 100 Tablet, Chewable In 1 Bottle
2
N N N N Y $2None$4None$2None
Carbamazepine 300mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbamazepine 100mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbamazepine 200mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbamazepine 200mg 100 Tablet, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbamazepine 400mg 100 Tablet, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbamazepine 100mg/5mL 450 Ml In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Carbatrol 100mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbatrol 200mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbatrol 300mg 120 Capsule, Extended Release In 1 Bottle
4
N N N N Y 35%None41%None35%None
Carbidopa And Levodopa 10; 100mg/1; mg 100 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 25; 100mg/1; mg 100 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 25; 250mg/1; mg 100 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 10; 100mg/1; mg 100 Tablet, Orally Disintegrating In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 25; 100mg/1; mg 100 Tablet, Orally Disintegrating In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 25; 250mg/1; mg 100 Tablet, Orally Disintegrating In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 50; 200mg/1; mg 100 Blister Pack In 1 Box, Unit-dose
3
N N N N Y 20%None25%None20%None
Carbidopa And Levodopa 25; 100mg/1; mg 100 Blister Pack In 1 Box, Unit-dose
3
N N N N Y 20%None25%None20%None
Carboplatin 10mg/mL 1 Vial In 1 Box > 15 Ml In 1 Vial
3
N N N N Y 20%None25%None20%None
Carisoprodol 350mg 100 Tablet In 1 Bottle, Plastic
2
N N Y N Y $2None$4None$2None
Carteolol Hydrochloride 10mg/mL 15 Ml In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cartia 120mg 90 Capsule, Extended Release In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Cartia 180mg 90 Capsule, Extended Release In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Cartia 240mg 90 Capsule, Extended Release In 1 Bottle
3
60 30 N N Y 20%None25%None20%None
Cartia 300mg 500 Capsule, Extended Release In 1 Bottle
3
30 30 N N Y 20%None25%None20%None
Carvedilol 3.125mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Carvedilol 6.25mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Carvedilol 12.5mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Carvedilol 25mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Cayston 2 Carton In 1 Package > 1 Kit In 1 Carton * 1 Ml In 1 Vial * 1 Ml In 1 Ampule
5
84 28 Y N Y 25%None25%None25%None
Cefaclor 500mg 100 Tablet, Film Coated, Extended Release In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefaclor 250mg 100 Capsule In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefaclor 500mg 100 Capsule In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefaclor 125mg/5mL 150 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefaclor 250mg/5mL 150 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefaclor 375mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefadroxil 1000mg 50 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefadroxil 500mg 100 Capsule In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefadroxil 250mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefadroxil 500mg/5mL 75 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefazolin 10g 10 Vial In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial
3
N N N N Y 20%None25%None20%None
Cefazolin 1g/50mL 24 Bag In 1 Case > 50 Ml In 1 Bag
3
N N N N Y 20%None25%None20%None
Cefazolin 500mg 10 Vial In 1 Carton
3
N N N N Y 20%None25%None20%None
Cefazolin 1g 25 Vial In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial
3
N N N N Y 20%None25%None20%None
Cefdinir 250mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefdinir 300mg 60 Capsule In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefdinir 125mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefepime 2g 10 Vial In 1 Box > 1 Injection, Powder, For Solution In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefepime 1g 1 Vial In 1 Box > 1 Injection, Powder, For Solution In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefotaxime 1g 25 Vial In 1 Package
2
N N N N Y $2None$4None$2None
Cefotaxime 2g 25 Vial In 1 Package
2
N N N N Y $2None$4None$2None
Cefotetan 1g/10mL 10 Vial In 1 Tray > 10 Ml In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefotetan 2g/20mL 10 Vial In 1 Tray > 20 Ml In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefotetan 10g 1 Vial In 1 Box > 1 Injection, Powder, For Solution In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefoxitin 1g 10 Vial In 1 Carton > 1 Powder In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefoxitin 2g 10 Vial In 1 Carton > 1 Powder In 1 Vial
4
N N N N Y 35%None41%None35%None
Cefoxitin 10g 10 Bottle In 1 Carton > 1 Injection, Powder, For Solution In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cefoxitin And Dextrose 1g/50mL 24 Container In 1 Case > 50 Ml In 1 Container
4
N N N N Y 35%None41%None35%None
Cefoxitin And Dextrose 2g/50mL 24 Container In 1 Case > 50 Ml In 1 Container
4
N N N N Y 35%None41%None35%None
Cefpodoxime Proxetil 200mg 100 Tablet, Film Coated In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cefpodoxime Proxetil 100mg 20 Tablet, Film Coated In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cefpodoxime Proxetil 50mg/5mL 1 Bottle In 1 Carton > 50 Ml In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cefpodoxime Proxetil 100mg/5mL 1 Bottle In 1 Carton > 50 Ml In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cefprozil 250mg 100 Tablet, Film Coated In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefprozil 125mg/5mL 75 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefprozil 250mg/5mL 75 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cefprozil 500mg 100 Tablet, Film Coated In 1 Bottle
3
N N N N Y 20%None25%None20%None
Ceftazidime 1g 25 Vial In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial
3
N N N N Y 20%None25%None20%None
Ceftazidime 2g 10 Vial In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial
3
N N N N Y 20%None25%None20%None
Ceftazidime 6g/30mL 6 Bottle In 1 Carton > 30 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Ceftazidime And Dextrose 1g/50mL 24 Container In 1 Case > 50 Ml In 1 Container
2
N N N N Y $2None$4None$2None
Ceftazidime And Dextrose 2g/50mL 24 Container In 1 Case > 50 Ml In 1 Container
2
N N N N Y $2None$4None$2None
Ceftriaxone 250mg 10 Carton In 1 Carton > 1 Injection, Powder, For Solution In 1 Carton
3
N N N N Y 20%None25%None20%None
Ceftriaxone 500mg 10 Vial In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial
3
N N N N Y 20%None25%None20%None
Ceftriaxone Sodium 1g 10 Vial, Single-use In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial, Single-use
3
N N N N Y 20%None25%None20%None
Ceftriaxone Sodium 10g/100mL 1 Vial, Pharmacy Bulk Package In 1 Carton > 100 Ml In 1 Vial, Pharmacy Bulk Package
3
N N N N Y 20%None25%None20%None
Ceftriaxone Sodium 2g 10 Vial, Single-use In 1 Carton > 1 Injection, Powder, For Solution In 1 Vial, Single-use
3
N N N N Y 20%None25%None20%None
Cefuroxime 1.5g 25 Injection In 1 Carton
3
N N N N Y 20%None25%None20%None
Cefuroxime 750mg 25 Injection In 1 Carton
3
N N N N Y 20%None25%None20%None
Cefuroxime 7.5g/80mL 10 Vial In 1 Carton > 80 Ml In 1 Vial
3
N N N N Y 20%None25%None20%None
Cefuroxime Axetil 500mg 20 Tablet, Film Coated In 1 Bottle
2
N N N N Y $2None$4None$2None
Cefuroxime Axetil 250mg 20 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Cellcept 250mg 1 Bottle, Plastic In 1 Carton > 500 Capsule In 1 Bottle, Plastic
4
N N Y N Y 35%None41%None35%None
Cellcept 500mg 1 Bottle, Plastic In 1 Carton > 500 Tablet, Film Coated In 1 Bottle, Plastic
5
N N Y N Y 25%None25%None25%None
Cellcept 200mg/mL 1 Bottle, Plastic In 1 Carton > 225 Ml In 1 Bottle, Plastic
5
N N Y N Y 25%None25%None25%None
Cellcept 500mg/20mL 4 Vial In 1 Carton > 20 Ml In 1 Vial
4
N N Y N Y 35%None41%None35%None
Celontin 300mg 100 Capsule In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cephalexin 250mg 100 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Cephalexin 500mg 100 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Cephalexin 125mg/5mL 200 Ml In 1 Bottle
2
N N N N Y $2None$4None$2None
Cephalexin 250mg/5mL 200 Ml In 1 Bottle
2
N N N N Y $2None$4None$2None
Cephalexin 500mg 500 Capsule In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Cephalexin 750mg 20 Capsule In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cephalexin 250mg 500 Capsule In 1 Bottle
1
N N N N Y $1None$2None$1None
Cervarix 20; 20ug/.5mL; ug/.5mL 10 Syringe In 1 Carton
4
N N N N Y 35%None41%None35%None
Cetirizine Hydrochloride 1mg/mL 120 Ml In 1 Bottle
2
300 30 N N Y $2None$4None$2None
Chantix .5mg 56 Tablet, Film Coated In 1 Bottle
4
56 28 N N Y 35%None41%None35%None
Chantix 1mg 56 Tablet, Film Coated In 1 Bottle
4
56 28 N N Y 35%None41%None35%None
Chantix 1 Kit In 1 Carton * 11 Tablet, Film Coated In 1 Blister Pack * 42 Tablet, Film Coated In 1 Blister Pack
4
56 28 N N Y 35%None41%None35%None
Chemet 100mg 100 Capsule In 1 Bottle
4
N N N N Y 35%None41%None35%None
Chenodal 250mg 100 Tablet, Film Coated In 1 Bottle, Plastic
5
N N Y N Y 25%None25%None25%None
Chloramphenicol Sodium Succinate 1g/10mL 10 Vial In 1 Tray > 10 Ml In 1 Vial
2
N N N N Y $2None$4None$2None
Chlorhexidine Gluconate 1.2mg/mL 473 Ml In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Chloroquine 500mg 25 Tablet, Coated In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Chloroquine Phosphate 250mg 50 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Chlorothiazide 250mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Chlorothiazide 500mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Chlorothiazide 500mg/18mL 1 Vial In 1 Box > 18 Ml In 1 Vial
2
N N N N Y $2None$4None$2None
Chlorpromazine Hydrochloride 25mg/mL 25 Ampule In 1 Carton
3
N N N N Y 20%None25%None20%None
Chlorpromazine Hydrochloride 50mg 100 Tablet, Sugar Coated In 1 Bottle
3
N N N N Y 20%None25%None20%None
Chlorpromazine Hydrochloride 10mg 100 Tablet, Sugar Coated In 1 Bottle
3
N N Y N Y 20%None25%None20%None
Chlorpromazine Hydrochloride 25mg 1000 Tablet, Sugar Coated In 1 Bottle
3
N N Y N Y 20%None25%None20%None
Chlorpromazine Hydrochloride 100mg 1000 Tablet, Sugar Coated In 1 Bottle
3
N N N N Y 20%None25%None20%None
Chlorpromazine Hydrochloride 200mg 1000 Tablet, Sugar Coated In 1 Bottle
3
N N N N Y 20%None25%None20%None
Chlorthalidone 50mg 1000 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Chlorthalidone 25mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cholestyramine Light 4g/5.7g 60 Pouch In 1 Carton > 5.7 G In 1 Pouch
4
N N N N Y 35%None41%None35%None
Chorionic Gonadotropin 1 Kit In 1 Carton * 10 Ml In 1 Vial, Multi-dose * 10 Ml In 1 Vial, Multi-dose
4
N N Y N Y 35%None41%None35%None
Ciclopirox 7.7mg/mL 60 Ml In 1 Bottle
4
N N N N Y 35%None41%None35%None
Ciclopirox 7.7mg/g 30 G In 1 Tube
4
N N N N Y 35%None41%None35%None
Ciclopirox 1mL/100mL 1 Bottle In 1 Carton > 120 Ml In 1 Bottle
4
N N N N Y 35%None41%None35%None
Ciclopirox 80mg/mL 6.6 Ml In 1 Bottle, With Applicator
4
N N N N Y 35%None41%None35%None
Ciclopirox Olamine 7.7mg/g 1 Tube In 1 Carton > 15 G In 1 Tube
4
N N N N Y 35%None41%None35%None
Cilostazol 50mg 60 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Cilostazol 100mg 60 Tablet In 1 Bottle
2
N N N N Y $2None$4None$2None
Cimetidine 400mg 100 Tablet, Film Coated In 1 Bottle
2
N N N N Y $2None$4None$2None
Cimetidine 200mg 100 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cimetidine 300mg 100 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cimetidine 800mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 Ml In 1 Bottle
2
N N N N Y $2None$4None$2None
Cinryze 500[iU]/5mL 1 Vial, Single-use In 1 Carton > 5 Ml In 1 Vial, Single-use
5
100 30 Y N Y 25%None25%None25%None
Ciprofloxacin 500mg 100 Tablet, Film Coated In 1 Bottle
1
N N N N Y $1None$2None$1None
Ciprofloxacin 250mg 100 Tablet, Film Coated In 1 Bottle
1
N N N N Y $1None$2None$1None
Ciprofloxacin 750mg 100 Tablet, Film Coated In 1 Bottle
2
N N N N Y $2None$4None$2None
Ciprofloxacin 400mg/40mL 1 Vial In 1 Carton > 40 Ml In 1 Vial
2
N N N N Y $2None$4None$2None
Ciprofloxacin 3mg/mL 1 Bottle, Dropper In 1 Carton > 5 Ml In 1 Bottle, Dropper
2
N N N N Y $2None$4None$2None
Ciprofloxacin 100mg 6 Tablet, Film Coated In 1 Package
2
N N N N Y $2None$4None$2None
Ciprofloxacin And Dextrose 2mg/mL 24 Bag In 1 Case > 100 Ml In 1 Bag
2
N N N N Y $2None$4None$2None
Cisplatin 100mg/100mL 1 Vial, Multi-dose In 1 Carton > 100 Ml In 1 Vial, Multi-dose
3
N N N N Y 20%None25%None20%None
Citalopram 10mg 100 Tablet In 1 Bottle
2
30 30 N N Y $2None$4None$2None
Citalopram Hydrobromide 40mg 30 Tablet In 1 Bottle
1
30 30 N N Y $1None$2None$1None
Citalopram Hydrobromide 20mg 1000 Tablet In 1 Bottle
1
60 30 N N Y $1None$2None$1None
Citalopram Hydrobromide 10mg/5mL 240 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Cladribine 1mg/mL 10 Ml In 1 Vial
5
N N N N Y 25%None25%None25%None
Claravis 10mg 10 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Claravis 20mg 10 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Claravis 30mg 3 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Claravis 40mg 10 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clarithromycin 250mg 60 Tablet, Coated In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Clarithromycin 500mg 60 Tablet, Coated In 1 Bottle, Plastic
3
N N N N Y 20%None25%None20%None
Clarithromycin 500mg 60 Tablet, Film Coated, Extended Release In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clarithromycin 125mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clarithromycin 250mg/5mL 100 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clemastine Fumarate .5mg/5mL 120 Ml In 1 Bottle
3
N N Y N Y 20%None25%None20%None
Cleocin Phosphate 12mg/mL 2 Carton In 1 Package
4
N N N N Y 35%None41%None35%None
Cleocin Phosphate 6mg/mL 2 Carton In 1 Package
4
N N N N Y 35%None41%None35%None
Cleocin Phosphate 18mg/mL 2 Carton In 1 Package
4
N N N N Y 35%None41%None35%None
Clindamycin Hydrochloride 75mg 200 Capsule In 1 Bottle
2
N N N N Y $2None$4None$2None
Clindamycin Hydrochloride 300mg 100 Capsule In 1 Bottle
2
N N N N Y $2None$4None$2None
Clindamycin Hydrochloride 150mg 100 Capsule In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Clindamycin In 5 Percent Dextrose 6mg/mL 24 Bag In 1 Carton
4
N N N N Y 35%None41%None35%None
Clindamycin In 5 Percent Dextrose 12mg/mL 24 Bag In 1 Carton
4
N N N N Y 35%None41%None35%None
Clindamycin In 5 Percent Dextrose 18mg/mL 24 Bag In 1 Carton
4
N N N N Y 35%None41%None35%None
Clindamycin Palmitate Hydrochloride (pediatric) 75mg/5mL 1 Bottle In 1 Carton > 100 Ml In 1 Bottle
4
N N N N Y 35%None41%None35%None
Clindamycin Phosphate 10mg/mL 1 Bottle In 1 Carton > 60 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clindamycin Phosphate 10mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
3
N N N N Y 20%None25%None20%None
Clindamycin Phosphate 10mg/mL 1 Bottle In 1 Carton > 60 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clindamycin Phosphate 20mg/g 40 G In 1 Tube, With Applicator
3
N N N N Y 20%None25%None20%None
Clindamycin Phosphate 10mg/mL 60 Applicator In 1 Jar > 1 Ml In 1 Applicator
3
N N N N Y 20%None25%None20%None
Clindamycin Phosphate And Benzoyl Peroxide 1 Kit In 1 Carton * 20 G In 1 Jar * 10 G In 1 Bottle, Plastic * 40 G In 1 Jar * 5 G In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clinimix 570; 316; 5; 283; 132; 165; 201; 159; 110; 154; 18mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 880; 489; 5; 438; 204; 255; 311; 247; 170; 238; 28mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 880; 489; 10; 438; 204; 255; 311; 247; 170; 238; 2mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 489; 20; 438; 204; 255; 311; 247; 170; 238; 289; 2mg/100mL; g/100mL; mg/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 880; 489; 25; 438; 204; 255; 311; 247; 170; 238; 2mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 1035; 575; 15; 515; 240; 300; 365; 290; 200; 280; mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 1035; 575; 20; 515; 240; 300; 365; 290; 200; 280; mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix 1035; 575; 25; 515; 240; 300; 365; 290; 200; 280; mg/100mL; mg/100mL; g/100mL; mg/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 1035; 575; 33; 15; 515; 240; 300; 365; 290; 51; 20mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 2000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 1035; 575; 33; 25; 515; 240; 300; 365; 290; 51; 20mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 2000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 570; 316; 33; 5; 283; 132; 165; 201; 159; 51; 110;mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 570; 316; 33; 10; 283; 132; 165; 201; 159; 51; 110mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 880; 489; 33; 5; 438; 204; 255; 311; 247; 51; 170;mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 880; 489; 33; 25; 438; 204; 255; 311; 247; 51; 170mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clinimix E 1035; 575; 33; 20; 515; 240; 300; 365; 290; 51; 20mg/100mL; mg/100mL; mg/100mL; g/100mL; mg/100mL; m 1000 Ml In 1 Bag
4
N N Y N Y 35%None41%None35%None
Clobetasol Propionate .05mg/g 1 Tube In 1 Carton > 60 G In 1 Tube
2
N N N N Y $2None$4None$2None
Clobetasol Propionate .4625mg/mL 1 Bottle In 1 Carton > 50 Ml In 1 Bottle
2
N N N N Y $2None$4None$2None
Clobetasol Propionate .5mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
2
N N N N Y $2None$4None$2None
Clobetasol Propionate .5mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
2
N N N N Y $2None$4None$2None
Clolar 1mg/mL 1 Vial, Single-use In 1 Carton > 20 Ml In 1 Vial, Single-use
5
N N N N Y 25%None25%None25%None
Clomipramine Hydrochloride 25mg 90 Capsule In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Clomipramine Hydrochloride 50mg 90 Capsule In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Clomipramine Hydrochloride 75mg 90 Capsule In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Clonazepam .5mg 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Clonazepam 2mg 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Clonazepam .125mg 10 Blister Pack In 1 Carton > 6 Tablet, Orally Disintegrating In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clonazepam .25mg 10 Blister Pack In 1 Carton > 6 Tablet, Orally Disintegrating In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clonazepam .5mg 10 Blister Pack In 1 Carton > 6 Tablet, Orally Disintegrating In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clonazepam 1mg 10 Blister Pack In 1 Carton > 6 Tablet, Orally Disintegrating In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clonazepam 2mg 10 Blister Pack In 1 Carton > 6 Tablet, Orally Disintegrating In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Clonazepam 1mg 90 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clonidine .1mg/d 4 Pouch In 1 Carton > 7 D In 1 Patch
4
4 28 N N Y 35%None41%None35%None
Clonidine .2mg/d 4 Pouch In 1 Carton > 7 D In 1 Patch
4
4 28 N N Y 35%None41%None35%None
Clonidine .3mg/d 4 Pouch In 1 Carton > 7 D In 1 Patch
4
4 28 N N Y 35%None41%None35%None
Clonidine Hydrochloride .2mg 500 Tablet In 1 Bottle
1
N N N N Y $1None$2None$1None
Clonidine Hydrochloride .1mg 500 Tablet In 1 Bottle, Plastic
1
N N N N Y $1None$2None$1None
Clonidine Hydrochloride .1mg 60 Tablet, Extended Release In 1 Bottle
4
120 30 N N Y 35%None41%None35%None
Clonidine Hydrochloride .3mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Clopidogrel Bisulfate 75mg 90 Tablet, Film Coated In 1 Bottle, Plastic
2
30 30 N N Y $2None$4None$2None
Clopidogrel Bisulfate 300mg 5 Blister Pack In 1 Carton
2
1 30 N N Y $2None$4None$2None
Clorazepate Dipotassium 3.75mg 500 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clorazepate Dipotassium 7.5mg 500 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clorazepate Dipotassium 15mg 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Clorpres 15; .1mg/1; mg 100 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clorpres 15; .2mg/1; mg 100 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clorpres 15; .3mg/1; mg 100 Tablet In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Clotrimazole 10mg 140 Lozenge In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Clotrimazole 10mg/mL 1 Bottle, Plastic In 1 Carton > 30 Ml In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Clotrimazole 10mg/g 2 Tube In 1 Carton > 45 G In 1 Tube
2
N N N N Y $2None$4None$2None
Clotrimazole And Betamethasone Dipropionate .5; 10mg/g; mg/g 45 G In 1 Tube
3
N N N N Y 20%None25%None20%None
Clotrimazole And Betamethasone Dipropionate .5; 10mg/mL; mg/mL 30 Ml In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clozapine 25mg 100 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clozapine 50mg 500 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clozapine 200mg 500 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Clozapine 100mg 100 Tablet In 1 Bottle
3
N N N N Y 20%None25%None20%None
Coartem 20; 120mg/1; mg 24 Tablet In 1 Bottle
4
24 30 N N Y 35%None41%None35%None
Codeine Sulfate 15mg 4 Blister Pack In 1 Box, Unit-dose > 25 Tablet In 1 Blister Pack
3
360 30 N N Y 20%None25%None20%None
Codeine Sulfate 30mg 100 Tablet In 1 Bottle
3
360 30 N N Y 20%None25%None20%None
Codeine Sulfate 60mg 100 Tablet In 1 Bottle
3
180 30 N N Y 20%None25%None20%None
Colcrys .6mg 100 Tablet, Film Coated In 1 Bottle, Plastic
3
120 30 N N Y 20%None25%None20%None
Colestipol Hydrochloride 1g 120 Tablet, Film Coated In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Colestipol Hydrochloride 5g 100 Suspension In 1 Bottle
4
N N N N Y 35%None41%None35%None
Collagenase Santyl 250[arb'U]/g 1 Tube In 1 Carton > 30 G In 1 Tube
4
N N N N Y 35%None41%None35%None
Colocort 100mg/60mL 7 Bottle, Dispensing In 1 Box > 60 Ml In 1 Bottle, Dispensing
4
N N N N Y 35%None41%None35%None
Coly-mycin 150mg/2mL 1 Vial In 1 Carton > 2 Ml In 1 Vial
4
N N N N Y 35%None41%None35%None
Combigan 2; 5mg/mL; mg/mL 1 Bottle, Dropper In 1 Carton > 5 Ml In 1 Bottle, Dropper
3
N N N N Y 20%None25%None20%None
Cometriq 4 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack
5
112 28 Y N Y 25%None25%None25%None
Cometriq 4 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack
5
56 28 Y N Y 25%None25%None25%None
Cometriq 20mg 4 Blister Pack In 1 Carton > 21 Capsule In 1 Blister Pack
5
84 28 Y N Y 25%None25%None25%None
Complera 200; 25; 300mg/1; mg/1; mg 30 Tablet, Film Coated In 1 Bottle
5
30 30 N N Y 25%None25%None25%None
Compro 25mg 12 Packet In 1 Carton > 1 Suppository In 1 Packet
3
N N N N Y 20%None25%None20%None
Comvax 7.5; 5ug/.5mL; ug/.5mL 10 Vial, Single-dose In 1 Carton
4
N N N N Y 35%None41%None35%None
Constulose 10g/15mL 946 Ml In 1 Bottle
2
N N N N Y $2None$4None$2None
Copaxone 20mg/mL 30 Blister Pack In 1 Carton > 1 Syringe, Glass In 1 Blister Pack > 1 Ml In 1 Syringe, Glass
5
30 30 Y N Y 25%None25%None25%None
Copaxone 40mg/mL 12 Blister Pack In 1 Carton > 1 Syringe, Glass In 1 Blister Pack > 1 Ml In 1 Syringe, Glass
5
12 28 Y N Y 25%None25%None25%None
Cortifoam 1500mg/15g 1 Container In 1 Carton > 15 G In 1 Container
4
N N N N Y 35%None41%None35%None
Cortisone Acetate 25mg 100 Tablet In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cosmegen .5mg/mL 12 Vial, Single-dose In 1 Carton > 1 Ml In 1 Vial, Single-dose
5
N N N N Y 25%None25%None25%None
Coumadin 4mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 1mg 10 Tablet In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Coumadin 2mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 5mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 7.5mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 10mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 2.5mg 1 Bottle In 1 Carton > 1000 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 3mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 6mg 1 Bottle In 1 Carton > 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Coumadin 2mg/mL 6 Carton In 1 Carton > 1 Vial In 1 Carton > 2.5 Ml In 1 Vial
4
N N N N Y 35%None41%None35%None
Creon 15000; 3000; 9500[USP'U]/1; [USP'U]/1; [USP'U] 1 Bottle In 1 Carton > 70 Capsule, Delayed Release In 1 Bottle
3
N N N N Y 20%None25%None20%None
Creon 30000; 6000; 19000[USP'U]/1; [USP'U]/1; [USP'U] 1 Bottle In 1 Carton > 100 Capsule, Delayed Release Pellets In 1 Bottle
3
N N N N Y 20%None25%None20%None
Creon 60000; 12000; 38000[USP'U]/1; [USP'U]/1; [USP'U] 100 Capsule, Delayed Release Pellets In 1 Bottle
3
N N N N Y 20%None25%None20%None
Creon 120000; 24000; 76000[USP'U]/1; [USP'U]/1; [USP'U] 100 Capsule, Delayed Release Pellets In 1 Bottle
3
N N N N Y 20%None25%None20%None
Creon 180000; 36000; 114000[USP'U]/1; [USP'U]/1; [USP'U] 250 Capsule, Delayed Release Pellets In 1 Bottle
3
N N N N Y 20%None25%None20%None
Crestor 10mg 90 Tablet, Film Coated In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Crestor 20mg 90 Tablet, Film Coated In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Crestor 40mg 30 Tablet, Film Coated In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Crestor 5mg 90 Tablet, Film Coated In 1 Bottle, Plastic
3
30 30 N N Y 20%None25%None20%None
Crixivan 200mg 360 Capsule In 1 Bottle
4
450 30 N N Y 35%None41%None35%None
Crixivan 400mg 180 Capsule In 1 Bottle
4
270 30 N N Y 35%None41%None35%None
Cromolyn Sodium 20mg/2mL 120 Vial, Single-dose In 1 Carton
3
N N Y N Y 20%None25%None20%None
Cromolyn Sodium 100mg/5mL 12 Pouch In 1 Carton > 8 Ampule In 1 Pouch > 5 Ml In 1 Ampule
5
N N N N Y 25%None25%None25%None
Cromolyn Sodium 40mg/mL 10 Ml In 1 Bottle, Plastic
2
N N N N Y $2None$4None$2None
Cryselle 6 Pouch In 1 Carton > 1 Blister Pack In 1 Pouch > 1 Kit In 1 Blister Pack
4
N N N N Y 35%None41%None35%None
Cubicin 500mg/10mL 1 Vial, Single-use In 1 Carton > 10 Ml In 1 Vial, Single-use
5
N N N N Y 25%None25%None25%None
Cuprimine 250mg 100 Capsule In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cyclafem 1/35 6 Blister Pack In 1 Carton
4
N N N N Y 35%None41%None35%None
Cyclafem 7/7/7 6 Blister Pack In 1 Carton
4
N N N N Y 35%None41%None35%None
Cyclobenzaprine Hydrochloride 5mg 100 Tablet, Film Coated In 1 Bottle, Plastic
4
N N Y N Y 35%None41%None35%None
Cyclobenzaprine Hydrochloride 10mg 1000 Tablet In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Cyclophosphamide 25mg 100 Tablet In 1 Bottle, Plastic
4
N N Y N Y 35%None41%None35%None
Cyclophosphamide 50mg 100 Tablet In 1 Bottle, Plastic
4
N N Y N Y 35%None41%None35%None
Cycloset .8mg 200 Tablet In 1 Bottle
4
180 30 N Y Y 35%None41%None35%None
Cyclosporine 25mg 30 Blister Pack In 1 Carton
4
N N Y N Y 35%None41%None35%None
Cyclosporine 50mg 30 Blister Pack In 1 Carton
4
N N Y N Y 35%None41%None35%None
Cyclosporine 100mg 30 Blister Pack In 1 Carton
4
N N Y N Y 35%None41%None35%None
Cyclosporine 100mg/mL 1 Bottle In 1 Package > 50 Ml In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Cyclosporine 50mg/mL 10 Ampule In 1 Carton > 5 Ml In 1 Ampule
4
N N Y N Y 35%None41%None35%None
Cyclosporine 25mg 30 Capsule, Liquid Filled In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Cyclosporine 100mg 30 Capsule, Liquid Filled In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Cyklokapron 100mg/mL 10 Ampule In 1 Box
3
N N Y N Y 20%None25%None20%None
Cyproheptadine Hydrochloride 4mg 100 Tablet In 1 Bottle
4
N N Y N Y 35%None41%None35%None
Cystadane 6g 180 Powder, For Solution In 1 Bottle
5
N N N N Y 25%None25%None25%None
Cystagon 50mg 500 Capsule In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Cystagon 150mg 500 Capsule In 1 Bottle, Plastic
4
N N N N Y 35%None41%None35%None
Cystaran 6.5mg/mL 15 Ml In 1 Bottle
5
60 28 Y N Y 25%None25%None25%None
Cytarabine 20mg/mL 1 Vial, Multi-dose In 1 Carton > 25 Ml In 1 Vial, Multi-dose
2
N N N N Y $2None$4None$2None
Cytarabine 100mg/mL 1 Vial, Single-dose In 1 Carton > 20 Ml In 1 Vial, Single-dose
2
N N N N Y $2None$4None$2None
Cytomel 5ug 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cytomel 25ug 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cytomel 50ug 100 Tablet In 1 Bottle
4
N N N N Y 35%None41%None35%None
Cytovene 500mg/10mL 25 Vial In 1 Carton > 10 Ml In 1 Vial
4
N N N N Y 35%None41%None35%None



Medicare Help's

Additional Notes:



Coverage Levels for S5884-110

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1.Pre-Deductable: Before you reach the plans deductible of $320. Some plans offer select Pre-deductible drug Coverage
2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $2960
3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $4700 in 2015.
4.Catastrophic: Anything over $4700 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2015 is $320. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Prefered: Your Cost for the Drug at the Providers In Network Prefered Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non Pref: Your Cost for the Prescription Drug at a Non-Prefered Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plans formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Source:CMS Formulary Data Oct. 2014
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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