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Medications
Nystatin / triamcinolone (Mycolog II and others) — plans on this site that list it on Tier 3
56 plans published on this site list this drug on Tier 3, grouped by company. Plans are sold by county — the service area under each plan shows where it is offered.
BayCare Health Plans
2 plans on this site
- BayCarePlus Complete (HMO) — Offered in FL: Hillsborough, Pasco, Pinellas, Polk
- BayCarePlus Rewards (HMO) — Offered in FL: Hillsborough, Pasco, Pinellas, Polk
Blue Cross Blue Shield of Arizona (AZ Blue)
1 plan on this site
- Blue Best Life Select (HMO) — Offered in AZ: Maricopa, Pinal
Dean Advantage
4 plans on this site
- Dean Advantage Assurance (HMO-POS) — Offered in WI: Columbia, Dane, Dodge, Fond du Lac, Green, Iowa, Jefferson, Rock, Sauk
- Dean Advantage Balance (HMO-POS) — Offered in WI: Columbia, Dane, Dodge, Fond du Lac, Green, Iowa, Jefferson, Rock, Sauk
- Dean Advantage Complete (HMO) — Offered in WI: Columbia, Dane, Dodge, Fond du Lac, Green, Iowa, Jefferson, Rock, Sauk
- Dean Advantage Essential (HMO) — Offered in WI: Columbia, Dane, Dodge, Fond du Lac, Green, Iowa, Jefferson, Rock, Sauk
Fallon Health
3 plans on this site
- Fallon Medicare Plus Blue (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
- Fallon Medicare Plus Green (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
- Fallon Medicare Plus Orange (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
Highmark Blue Cross Blue Shield
2 plans on this site
- Highmark Health Options Duals (HMO D-SNP) — Offered in WV: 40 counties
- Highmark Health Options Duals Select (HMO D-SNP) — Offered in DE: Kent, New Castle, Sussex
Highmark Wholecare Medicare Assured
2 plans on this site
- Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) — Offered in PA: 57 counties
- Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) — Offered in PA: 57 counties
Mass General Brigham Health Plan
3 plans on this site
- Mass General Brigham Advantage Core (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
- Mass General Brigham Advantage Plus (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
- Mass General Brigham Advantage Secure (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
SCAN Health Plan
32 plans on this site
- CareMore Health Plan by SCAN (HMO) — Offered in CA: Los Angeles, Orange
- SCAN Allied (HMO) — Offered in CA: San Francisco, San Mateo
- SCAN Alta (HMO) — Offered in CA: San Diego
- SCAN Ansim Care (HMO C-SNP) — Offered in CA: Los Angeles, Orange
- SCAN Baekse (HMO) — Offered in CA: Los Angeles, Orange
- SCAN Balance (HMO C-SNP) — Offered in CA: Fresno, Kings, Madera, Tulare
- SCAN Balance Texas (HMO C-SNP) — Offered in TX: Bexar, Chambers, Fort Bend, Harris, Liberty, Montgomery
- SCAN Classic (HMO) — Offered in CA: Fresno, Kings, Madera, Tulare
- SCAN Classic Texas (HMO) — Offered in TX: Bexar, Chambers, Fort Bend, Harris, Liberty, Montgomery
- SCAN Classic WA (HMO) — Offered in WA: Pierce, Spokane, Thurston
- SCAN Connections (HMO D-SNP) — Offered in CA: Los Angeles, Riverside, San Bernardino, San Diego
- SCAN Connections at Home (HMO D-SNP) — Offered in CA: Los Angeles, Riverside, San Bernardino, San Diego
- SCAN Costco Medicare Advantage (HMO) — Offered in CA: Placer, Sacramento, San Joaquin, Yolo
- SCAN Desert Choice (HMO) — Offered in CA: Riverside
- SCAN Embrace (HMO I-SNP) — Offered in CA: Los Angeles
- SCAN Embrace (HMO-POS I-SNP) — Offered in AZ: Maricopa, Pima
- SCAN Embrace Together (HMO I-SNP) — Offered in CA: Los Angeles, Orange
- SCAN Embrace Together (HMO-POS I-SNP) — Offered in AZ: Maricopa, Pima
- SCAN Essential Savings (HMO) — Offered in CA: Los Angeles
- SCAN Inclusive (HMO) — Offered in CA: Los Angeles, Orange, Riverside, San Bernardino
- SCAN Inspired by women for women (HMO) — Offered in CA: Los Angeles, Orange
- SCAN MyChoice (HMO) — Offered in AZ: Maricopa, Pima, Pinal
- SCAN Prime (HMO) — Offered in CA: Los Angeles, Orange, San Bernardino
- SCAN Select (HMO) — Offered in CA: San Diego
- SCAN Strive (HMO C-SNP) — Offered in CA: 14 counties
- SCAN Venture (HMO) — Offered in CA: Los Angeles, Orange
- SCAN Walmart Health Advantage (HMO) — Offered in TX: Bexar, Chambers, Fort Bend, Harris, Liberty, Montgomery
- SCAN Walmart Medicare Advantage (HMO) — Offered in AZ: Maricopa, Pima, Pinal
- SCAN Walmart Medicare Complete (HMO C-SNP) — Offered in TX: Bexar, Chambers, Fort Bend, Harris, Liberty, Montgomery
- Springs Advantage, a SCAN Medicare Plan (HMO-POS I-SNP) — Offered in OR: Clackamas, Washington
- Springs Together, a SCAN Medicare Plan (HMO-POS I-SNP) — Offered in OR: Clackamas, Washington
- Sutter Senior Advantage, a SCAN Medicare Plan (HMO) — Offered in CA: Placer, Sacramento, Yolo
Samaritan Advantage Health Plans
1 plan on this site
- Samaritan Dual Advantage (HMO D-SNP) — Offered in OR: Benton, Lincoln, Linn
Select Health
4 plans on this site
- Select Health Medicare Dual (HMO D-SNP) — Offered in UT: Davis, Iron, Salt Lake, Utah, Washington, Weber
- Select Health Medicare Essential (HMO) — Offered in CO: Adams, Arapahoe, Denver, Douglas, El Paso, Elbert, Jefferson, Pueblo, Teller
- Select Health Medicare Value Giveback (HMO) — Offered in NV: Clark, Nye
- Select Health Medicare Wellness (HMO) — Offered in NV: Clark, Nye
VillageHealth
2 plans on this site
- SCAN DaVita Dialysis Care (HMO-POS C-SNP) — Offered in CA: Orange, Riverside, San Bernardino
- SCAN DaVita Dialysis Care Complete (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange, Riverside, San Bernardino
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage.
Source: CMS Prescription Drug Plan Formulary data + this site's published plan records · List built 2026-11-08