hydrocodone/acetaminophen 5/300, 7.5/300. Tier 1. QL hydrocodone lisinopril. Tier 1 lisinopril/hydrochlorothiazide. Tier 1 lithium
Tier 1 lindane. Tier 1 liothyronine. Tier 1 lisinopril. Tier 1 lisinopril/hydrochlorothiazide. Tier 1 lithium carbonate. Tier 1. This drug may
lisinopril. Tier 1 lisinopril/hydrochlorothiazide. Tier 1 lithium phentermine. Tier 1 phenytoin sodium. Tier 1 phenytoin sodium ext-rel.
Effective Date . 1 of 25. Drug Name. Tier 1 Tier 2 Tier 3 Tier 4 Generic Lisinopril, generic Moexepril, generic Enalapril, generic. Captopril
lisinopril) - Tier 2; PA; QL. Tier 1: Generic; Tier 2: Brand; AL (loratadine) (generic for CLARITIN ALLERGY. CHILDRENS) - Tier 1; QL.
Lisinopril Lisinopril / hydrochlorothiazide Losartan Losartan / hydrochlorothiazide Quinapril Ramipril Trandolapril Valsartan Valsartan / hydrochlorothiazide Atorvastatin Lovastatin Pravastatin Rosuvastatin Glimepiride Glipizide Glipizide / metformin New for 2024 Medicare Select Care Tier (Tier 6) Drugs in the Select Care tier (Tier 6) have a
What does each drug tier mean? Tier 1: Preferred generic drugs Tier 2: Generic drugs Tier 3: Preferred brand drugs Tier 4: Nonpreferred drugs Tier 5:
LISINOPRIL-HCTZ .5 MG TAB. Tier 1. 30. $. $10.00. LISINOPRIL-HCTZ .5 MG TAB. Tier 1. 30. $. $10.00. LISINOPRIL-HCTZ MG TAB. Tier
Most prescription insurance plans are accepted. Page 2. A. ALBUTEROL LISINOPRIL 10 MG TAB. Tier 1. 30. $. $10.00. LISINOPRIL 20 MG TAB. Tier 1.
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