.
.
.
. . .
. . .
Q1 Medicare.com Click to Enter Your Drugs and Compare Medicare Part D Plans
Powered by Q1Group LLC Powered by Q1Group LLC.
Education and Decision Support Tools for the Medicare Community
.
. . .
. . .
. . .
.
. Home Contact Us Enroll . .
. . MAPD PDP 2014 FAQ Blog
.
. . .
. . . . . . .
.
.
: : Compare 2013 Medicare Rx and Health Plans by Drug Costs
: : See 2013 Medicare Drug Plans
: : 2013 Medicare Advantage Plans
: : Browse Any 2013 Plan Formulary
: : Compare a Drug's Coverage Across All 2013 Drug Plans
: : Newsletter Sign-up
. . . .
Special Features
Find a 2013 Part D Plan (Rx Only)
Find a 2013 Medicare Advantage Plan (Health and Health w/Rx Plans)
Browse Any 2013 Medicare Plan Formulary (or Drug List) Updated!
Find a 2013 Medicare Part D or Medicare Advantage Plan by Drug
Compare Part D and Medicare Advantage Plans by Drug Costs
2013 National Plan Overview by State
PDP and MAPD Overview by State
PDP Overview by CMS Region
Medicare Part D
Medicare Part D - Blog
Enrollment Tips
2013 Medicare Part D Plan Information
2014 Medicare Part D Outlook
Medicare.gov Tutorial
The Basics of Medicare Part D
The Donut Hole and Beyond
How Part D Plans Work
Which Drugs are Covered?
Which Drugs are Excluded?
Understanding Your Explanation of Benefits
Formulary Exceptions
(Coverage Determinations),
Appeals & Grievances
Choosing a Plan: The Basics
Your Medicare Part D Checklist
Tips from CMS
Important Dates
The Late Enrollment Penalty
Out-of-Pocket Cost Estimator
After Enrollment into Part D
Financial "Extra Help"
Part D Scams - Watch Out!
Doughnut Hole Calculator
Medicare Advantage Plans
2013 Medicare Advantage Plan Benefit Details
Medicare Advantage Plans State Overview
Find a Medicare Advantage Plan by Drug Costs
Medicare Overview
Medicare & You Handbook
Guide to Rx Coverage
Plan Archives
2012 Medicare Part D Archive
2012 Medicare Part D Plan Information
2012 Medicare Part D Plans (PDP-Finder: Rx Only)
2012 Medicare Advantage Plans (Health and Health w/Rx Plans)
2012 Medicare Part D or Medicare Advantage Plan by Drug
Browse Any 2012 Medicare Plan Formulary (Drug List)
2012 Plan’s Retail Drug Price Details
2012 National Plan Overview by State
2012 PDP & MAPD Overview by State
2012 Overview by CMS PDP Region
Guided Help on 2012 Medicare Prescription Drug Plans
PDP-Compare: How will each 2011 Part D Plan Change in 2012?
MA-Compare: Review Changes in each 2011 Medicare Advantage Plan for 2012
Search for 2012 Medicare Plans by Plan ID
Search for 2012 Medicare Plans by Formulary ID
2012 Part D Plan Facts & Figures
2012 Part D Facts & Figures in Plain Text
2012 PDP-Planner & Donut Hole Calculator
2012 Cost Estimator
2011 Medicare Part D Archive
2010 Medicare Part D Archive
2009 Medicare Part D Archive
2008 Medicare Part D Archive
2007 Medicare Part D Archive
2006 Medicare Part D Archive
Pre-2010 Medicare.gov Tutorial
Support Center
Medicare.gov Tutorial


. .

2012 Medicare Part D and Medicare Advantage Plan Formulary Browser
. .
Search by   State & Plan   ZIP & Plan   PlanID   FormularyID .
Search Criteria
PlanType:* PDP     MAPD
State:*
Plan Family:*
Selected Plan:CVS Caremark Value (PDP) (S5601-044-0)
Browse Formulary by
First Letter of Drug Name:		   A  B  C  D  E  F  G  H  I  J  K  L  M
  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
  *required
: :Example: AARP MedicareRx Preferred (PDP) Formulary in Florida
 
: :Go to TX’s 2012 Plan Page for plan materials
: :Print Version
: :2012 Plan Finder
: :Compare 2011 & 2012 Plans
2012 Medicare Part D Plan Formulary Information
CVS Caremark Value (PDP) (S5601-044-0)          
The CVS Caremark Value (PDP) (S5601-044-0) Formulary for Drugs Starting with the Letter L
in CMS PDP Region 22 which includes: TX
Plan Monthly Premium: $28.30 Deductible: $320 Qualifies for LIS: Yes
Drugs Start with Letter L

Drug Name		 Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order
L1 PROTEIN, HUMAN PAPILLOMAVIRUS TYPE 16 VACCINE 0.04 MG/ML / L1 PROTEIN, HUMAN PAPILLOMAVIRU   2 Preferred Brand Drugs $45.00 $101.25 None
L1 PROTEIN, HUMAN PAPILLOMAVIRUS TYPE 16 VACCINE 0.04 MG/ML / L1 PROTEIN, HUMAN PAPILLOMAVIRUS TYPE   2 Preferred Brand Drugs $45.00 $101.25 None
LABETALOL HCL 100MG TABLET   1 Generic Drugs $7.50 $11.25 None
LABETALOL HCL 200MG TABLET   1 Generic Drugs $7.50 $11.25 None
LABETALOL HCL 300MG TABLET   1 Generic Drugs $7.50 $11.25 None
LABETALOL HCL 5MG/20ML VIAL   1 Generic Drugs $7.50 $11.25 None
LACLOTION 12% LOTION   1 Generic Drugs $7.50 $11.25 None
LACRISERT OPTHALMIC INSERT 5MG 60 BLPK   2 Preferred Brand Drugs $45.00 $101.25 None
LACTATED RINGERS INJECTION   1 Generic Drugs $7.50 $11.25 None
LACTULOSE SOLUTION ORAL 10GM/15ML 946ML BOT   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LAMIVUDINE 150 MG TABLET   1 Generic Drugs $7.50 $11.25 None
LAMIVUDINE 300 MG TABLET   1 Generic Drugs $7.50 $11.25 None
LAMIVUDINE-ZIDOVUDINE TABLET   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE 150MG TABLET (60 CT)   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE 200MG TABLET (60 CT)   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE 25MG TABLET (100 CT)   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE 25MG TABLET DISPERSIBLE   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE 5MG TABLET DISPERSIBLE   1 Generic Drugs $7.50 $11.25 None
LAMOTRIGINE TABLET 100MG (100 CT)   1 Generic Drugs $7.50 $11.25 None
LANOXIN 0.125MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 None
LANOXIN 0.25MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LANTUS 100U/ML VIAL   2 Preferred Brand Drugs $45.00 $101.25 None
LANTUS SOLOSTAR INJECTION   2 Preferred Brand Drugs $45.00 $101.25 None
LATANOPROST OPHTHALMIC SOLUTION .005%   1 Generic Drugs $7.50 $11.25 Q:3/30Days
LATUDA 20 MG TABLET   3 Non-Preferred Brand Drugs $95.00 $261.25 None
Latuda 40mg/1   3 Non-Preferred Brand Drugs $95.00 $261.25 None
Latuda 80mg/1   3 Non-Preferred Brand Drugs $95.00 $261.25 None
LEENA 7-9-5 TABLET   1 Generic Drugs $7.50 $11.25 None
LEFLUNOMIDE 10MG TABLET   1 Generic Drugs $7.50 $11.25 None
LEFLUNOMIDE TABLETS   1 Generic Drugs $7.50 $11.25 None
Lessina 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK   1 Generic Drugs $7.50 $11.25 None
Letrozole 2.5mg/1 500 TABLET, FILM COATED in 1 BOTTLE, PLASTIC   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEUCOVORIN CALCIUM 100MG VL   1 Generic Drugs $7.50 $11.25 P
LEUCOVORIN CALCIUM 10MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 None
Leucovorin Calcium 15mg/1 24 TABLET in 1 BOTTLE   2 Preferred Brand Drugs $45.00 $101.25 None
LEUCOVORIN CALCIUM 25MG TABLET   1 Generic Drugs $7.50 $11.25 None
LEUCOVORIN CALCIUM 350MG VL   1 Generic Drugs $7.50 $11.25 P
LEUCOVORIN CALCIUM 5MG TABLET   1 Generic Drugs $7.50 $11.25 None
LEUKERAN 2MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 None
LEUPROLIDE ACETATE INJECTION   1 Generic Drugs $7.50 $11.25 P
LEVALBUTEROL 1.25 MG/0.5 ML   1 Generic Drugs $7.50 $11.25 P
LEVEMIR 100UNITS/ML VIAL   2 Preferred Brand Drugs $45.00 $101.25 None
Levemir 14.2mg/mL 5 SYRINGE, PLASTIC in 1 CARTON / 3 mL in 1 SYRINGE, PLASTIC   2 Preferred Brand Drugs $45.00 $101.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEVETIRACETAM 100 MG/ML SOLN 100MG/ML 16 FL OZ BOT   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM 500 MG TABLET 120 BOT   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM ER 500 MG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM ER 750 MG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM INJECTION   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM TABLETS 1000MG 60 BOT   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM TABLETS 250MG 500 BOT   1 Generic Drugs $7.50 $11.25 None
LEVETIRACETAM TABLETS 750MG 500 BOT   1 Generic Drugs $7.50 $11.25 None
LEVOBUNOLOL 0.25% EYE DROPS   1 Generic Drugs $7.50 $11.25 None
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION   1 Generic Drugs $7.50 $11.25 None
LEVOCARNITINE 100MG/ML SOLUTION ORAL   1 Generic Drugs $7.50 $11.25 P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEVOCARNITINE TABLET 330MG 90 BLPK   1 Generic Drugs $7.50 $11.25 P
LEVOCETIRIZINE 2.5 MG/5 ML SOL   1 Generic Drugs $7.50 $11.25 None
Levocetirizine dihydrochloride 5mg/1 30 TABLET in 1 BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 250mg/1   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 25mg/mL 1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 25mg/mL 1 VIAL in 1 CARTON / 30 mL in 1 VIAL   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 500mg/1   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 5mg/mL 24 POUCH in 1 CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG   1 Generic Drugs $7.50 $11.25 None
Levofloxacin 750mg/1   1 Generic Drugs $7.50 $11.25 None
LEVORA-28 TABLET 0.15/30   1 Generic Drugs $7.50 $11.25 None
Levothroid 100ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
Levothroid 112ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 125ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 137ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 150ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 175ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 200ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 25ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 300ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 50ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 75ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Levothroid 88ug/1 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEVOTHYROXINE SODIUM .075MG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM .150MG TABLET (100 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 100MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 112MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 125MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 137MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 175MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 200MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 25MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 300MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOTHYROXINE SODIUM 50MCG TABLET   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEVOTHYROXINE SODIUM 88MCG TABLET   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 100MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 112MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 125MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 137MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 150MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 175MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 200MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 25MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 50MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEVOXYL 75MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LEVOXYL 88MCG TABLET (1000 CT)   1 Generic Drugs $7.50 $11.25 None
LEXIVA 50mg/mL 225 mL in 1 BOTTLE   2 Preferred Brand Drugs $45.00 $101.25 None
LEXIVA TABLETS   2 Preferred Brand Drugs $45.00 $101.25 None
LIALDA 1.2G TABLET DELAYED RELEASE   2 Preferred Brand Drugs $45.00 $101.25 None
LIDOCAINE 5% OINTMENT   1 Generic Drugs $7.50 $11.25 None
LIDOCAINE HCL 0.5% VIAL   1 Generic Drugs $7.50 $11.25 None
LIDOCAINE HCL 1% VIAL   1 Generic Drugs $7.50 $11.25 None
lidocaine hcl 2% jelly   1 Generic Drugs $7.50 $11.25 None
LIDOCAINE HCL 2% JELLY 30ML TUBE   1 Generic Drugs $7.50 $11.25 None
LIDOCAINE HCL TOPICAL SOLUTION 4% 50ML BOT   1 Generic Drugs $7.50 $11.25 None
LIDOCAINE HYDROCHLORIDE ORAL TOPICAL SOLUTION 20MG 100 ML BOT   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LIDOCAINE-PRILOCAINE 2.5%-2.5% CREAM   1 Generic Drugs $7.50 $11.25 P
LIDODERM 5% PATCH   2 Preferred Brand Drugs $45.00 $101.25 Q:90/30Days
LIOTHYRONINE SODIUM TABLETS 25MCG 100 TABLETS BOT   1 Generic Drugs $7.50 $11.25 None
LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT   1 Generic Drugs $7.50 $11.25 None
LIOTHYRONINE SODIUM TABLETS 5MCG 100 TABLETS BOT   1 Generic Drugs $7.50 $11.25 None
LIPOFEN CAPSULES   2 Preferred Brand Drugs $45.00 $101.25 None
LIPOSYN II 10% IV FAT EMUL   2 Preferred Brand Drugs $45.00 $101.25 P
Liposyn III 1.2; 2.5; 10g/100mL; g/100mL; g/100mL 12 BOTTLE, GLASS in 1 CASE / 250 mL in 1 BOTTLE,   2 Preferred Brand Drugs $45.00 $101.25 P
Liposyn III 1.2; 2.5; 20g/100mL; g/100mL; g/100mL 12 BOTTLE, GLASS in 1 CASE / 250 mL in 1 BOTTLE,   2 Preferred Brand Drugs $45.00 $101.25 P
LIPOSYN III 30% IV FAT EMUL   1 Generic Drugs $7.50 $11.25 P
LISINOPRIL 10MG TABLET (100 CT)   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
Lisinopril 2.5mg 100 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL 20MG TABLET   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL 30MG TABLET (100 CT)   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL 40MG TABLET (500 CT)   1 Generic Drugs $7.50 $11.25 None
Lisinopril 5mg/1 1000 TABLET in 1 BOTTLE   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL-HCTZ 10/12.5 TABLET   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL-HCTZ 20-25MG TABLET (100 CT)   1 Generic Drugs $7.50 $11.25 None
LISINOPRIL-HCTZ 20/12.5 TABLET   1 Generic Drugs $7.50 $11.25 None
LITHIUM CARBONATE 150MG CAPSULE   1 Generic Drugs $7.50 $11.25 None
LITHIUM CARBONATE 300MG CAPSULE (100 CT)   1 Generic Drugs $7.50 $11.25 None
LITHIUM CARBONATE 300MG TABLET   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
Lithium Carbonate 450mg/1   1 Generic Drugs $7.50 $11.25 None
LITHIUM CARBONATE CAPSULES   1 Generic Drugs $7.50 $11.25 None
LITHIUM CARBONATE ER TABLET 300MG (100 CT)   1 Generic Drugs $7.50 $11.25 None
LITHIUM CIT 8MEQ/5ML SYRUP   2 Preferred Brand Drugs $45.00 $101.25 None
LOKARA 0.05% LOTION   1 Generic Drugs $7.50 $11.25 None
LOPERAMIDE HCL 2MG CAPSULE   1 Generic Drugs $7.50 $11.25 None
LOSARTAN POTASSIUM 100 MG TAB   1 Generic Drugs $7.50 $11.25 None
LOSARTAN POTASSIUM 25 MG TAB   1 Generic Drugs $7.50 $11.25 None
LOSARTAN POTASSIUM 50 MG TAB   1 Generic Drugs $7.50 $11.25 None
LOSARTAN-HCTZ 100-12.5 MG TAB   1 Generic Drugs $7.50 $11.25 None
LOSARTAN-HCTZ 100-25 MG TAB   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LOSARTAN-HCTZ 50-12.5 MG TAB   1 Generic Drugs $7.50 $11.25 None
LOTRONEX TABLETS .5MG 30 BOTPL   2 Preferred Brand Drugs $45.00 $101.25 None
LOTRONEX TABLETS 1MG 30 BOTPL   2 Preferred Brand Drugs $45.00 $101.25 None
Lovastatin 10mg 60 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
Lovastatin 20mg 500 TABLET BOTTLE   1 Generic Drugs $7.50 $11.25 None
LOVASTATIN 40 MG ORAL TABLET   1 Generic Drugs $7.50 $11.25 None
LOVAZA 1g/ 120 LIQUID FILLED CAPSULES in BOTTLE   3 Non-Preferred Brand Drugs $95.00 $261.25 None
LOW-OGESTREL-28 TABLET   1 Generic Drugs $7.50 $11.25 None
LOXAPINE 25MG CAPSULE (100 CT)   1 Generic Drugs $7.50 $11.25 None
LOXAPINE CAPSULES 10MG 100 BOT   1 Generic Drugs $7.50 $11.25 None
LOXAPINE CAPSULES 50MG 100 BOT   1 Generic Drugs $7.50 $11.25 None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LOXAPINE CAPSULES 5MG 100 BOT   1 Generic Drugs $7.50 $11.25 None
LUMIGAN 0.03% EYE DROPS   2 Preferred Brand Drugs $45.00 $101.25 Q:3/30Days
LUMIGAN 0.1mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 5 mL in 1 BOTTLE, DROPPER   2 Preferred Brand Drugs $45.00 $101.25 Q:3/30Days
LUNESTA 2MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 Q:30/30Days
LUNESTA 3MG TABLET   2 Preferred Brand Drugs $45.00 $101.25 Q:30/30Days
LUNESTA TABLETS 1MG 30 BOT   2 Preferred Brand Drugs $45.00 $101.25 Q:30/30Days
LUPRON DEPOT 11.25 MG 3MO KIT   2 Preferred Brand Drugs $45.00 $101.25 P
LUPRON DEPOT 3.75 MG KIT   2 Preferred Brand Drugs $45.00 $101.25 P
LUTERA 0.1-0.02 TABLET   1 Generic Drugs $7.50 $11.25 None
LYRICA 100MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
LYRICA 150MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
LYRICA 200MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
LYRICA 225MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
LYRICA 25MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
LYRICA 300MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:60/30Days
LYRICA 50MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days
LYRICA 75MG CAPSULE   2 Preferred Brand Drugs $45.00 $101.25 Q:120/30Days



What does all this mean? Here are a few notes to help you understand the above 2012 Medicare Part D CVS Caremark Value (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 $320 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 $2930) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2012 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 September 2012 )

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.



Click the +1 button if you have found this page useful:  

.
.
Medicare Supplements
fill the gaps in your
Original Medicare
1. Select Your State:
.


.
.

.
Medicare PartD MAPD and PDP plan comparisons .
Quick Links
: : Find a 2013 Plan by Drug Costs
: : 2013 Part D Plan Facts & Figures
: : 2013 Part D PDP-Finder (Drug Only) Plan Finder
: : Compare 2012/2013 PDP Plans
: : 2013 MA-Finder: Medicare Advantage Plan Finder
: : Compare 2012/2013 Medicare Advantage Plans
: : Guided Help Finding a 2013 Prescription Drug Plan
: : 2013 Part D Drug Finder
: : Browse Any 2013 Part D Plan Formulary
: : 2013 Browse Drugs By Letter
: : RxSavings-Center
: : 2014 Plan Information Reminder Service
.

: : Click here to link to this page on your website
.

    Follow Q1Medicare on Twitter
.

   
. . .
. . .
.
.
What’s New Most Viewed Press . .
.
. . .
.
Sitemap About Us Privacy Policy Newsletter Sign-up Blog FAQ Contact Us Terms Of Use Newsroom
. Enroll in Medicare Part D © Q1Group LLC 2005 - 2013 . .
. . .
. . .
.
.
. .

.
.
.