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2012 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:
Links to Summaries by State for LTC Drugs on LIS/SNP Plans:
AK  AL  AR  AZ  CA  CO  CT  DC  DE  FL  GA  HI  IA  ID  IL  IN  KS  KY  LA  MA  MD  ME  MI  MN  MO  MS  MT  NC  ND  NE  NH  NJ  NM  NV  NY  OH  OK  OR  PA  PR  RI  SC  SD  TN  TX  UT  VA  VT  WA  WI  WV  WY

Drug Names Containing the Letter R in Alphabetical Order.
Example: Lipitor® is found on letter page "L" as well as letter page "A" for Atorvastatin.

Drug Name
PackagingNDCOn This Nbr of 2012 Formularies
PDPsMAPDs
ACIPHEX 20MG TABLET EC
(Rabeprazole Sodium EC)
30 BOT6285602433022
PDPs
65
MAPDs
Actonel 150mg/1 36 DOSE PACK in 1 CASE / 1 TRAY in 1 DOSE PACK / 1 TABLET, FILM COATED in 1 TRAY
(Risedronate Sodium)
36 DOSE PACK in 1 CASE /  0043004780157
PDPs
186
MAPDs
Actonel 30mg/1 12 BOTTLE in 1 CASE / 30 TABLET, FILM COATED in 1 BOTTLE
(Risedronate Sodium)
12 BOTTLE in 1 CASE / 30  0043004701557
PDPs
186
MAPDs
Actonel 35mg/1 36 DOSE PACK in 1 CASE / 1 TRAY in 1 DOSE PACK / 4 TABLET, FILM COATED in 1 TRAY
(Risedronate Sodium)
36 DOSE PACK in 1 CASE /  0043004720357
PDPs
187
MAPDs
Actonel 5mg/1 12 BOTTLE in 1 CASE / 30 TABLET, FILM COATED in 1 BOTTLE
(Risedronate Sodium)
12 BOTTLE in 1 CASE / 30  0043004711557
PDPs
188
MAPDs
ALTABAX 10mg/g 30 g in 1 TUBE
(Retapamulin)
30 g in 1 TUBE  0000751802541
PDPs
115
MAPDs
ALTACE 1.25MG CAPSULE
(Ramipril)
100 CAPS BOTPL6157001100115
PDPs
51
MAPDs
ALTACE 10MG CAPSULE (100 CT)
(Ramipril)
100 CAPS BOTPL6157001200115
PDPs
50
MAPDs
ALTACE 2.5 MG CAPSULE
(Ramipril)
100 EA  6157001110115
PDPs
50
MAPDs
ALTACE 5MG CAPSULE
(Ramipril)
100 BOT6157001120115
PDPs
50
MAPDs
ARCALYST INJECTION 220MG/VIAL
(Rilonacept For)
4 VIALSD CRTN6175500010171
PDPs
245
MAPDs
Atelvia 35mg/1 36 DOSE PACK in 1 CASE / 4 TABLET, DELAYED RELEASE in 1 DOSE PACK
(RISEDRONATE SODIUM)
36 DOSE PACK in 1 CASE /  0043009790333
PDPs
86
MAPDs
AVANDAMET 1000; 2mg/1; mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Metformin HCl)
60 TABLET, FILM COATED in  0017308381844
PDPs
162
MAPDs
AVANDAMET 1000; 4mg/1; mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Metformin HCl)
60 TABLET, FILM COATED in  0017308401844
PDPs
162
MAPDs
AVANDAMET 500; 2mg/1; mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Metformin HCl)
60 TABLET, FILM COATED in  0017308371844
PDPs
162
MAPDs
AVANDAMET 500; 4mg/1; mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Metformin HCl)
60 TABLET, FILM COATED in  0017308391844
PDPs
162
MAPDs
AVANDARYL 1; 4mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Glimepiride)
30 TABLET, FILM COATED in  0017308411343
PDPs
157
MAPDs
AVANDARYL 2; 4mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Glimepiride)
30 TABLET, FILM COATED in  0017308421343
PDPs
157
MAPDs
AVANDARYL 2; 8mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Glimepiride)
30 TABLET, FILM COATED in  0017308441342
PDPs
149
MAPDs
AVANDARYL 4; 4mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Glimepiride)
30 TABLET, FILM COATED in  0017308431343
PDPs
157
MAPDs
AVANDARYL 4; 8mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate-Glimepiride)
30 TABLET, FILM COATED in  0017308451342
PDPs
149
MAPDs
AVANDIA 2mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate)
60 TABLET, FILM COATED in  0017308341844
PDPs
166
MAPDs
AVANDIA 4mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate)
30 TABLET, FILM COATED in  0017308351344
PDPs
166
MAPDs
AVANDIA 8mg/1 30 TABLET, FILM COATED in 1 BOTTLE
(Rosiglitazone Maleate)
30 TABLET, FILM COATED in  0017308361344
PDPs
166
MAPDs
AZILECT 0.5MG TABLET
(Rasagiline Mesylate)
30 BOT6854601425666
PDPs
219
MAPDs
AZILECT 1MG TABLET
(Rasagiline Mesylate)
30 BOT6854602295666
PDPs
219
MAPDs
Banzel 200mg/1
(Rufinamide)
   6285605825271
PDPs
245
MAPDs
Banzel 40mg/mL
(Rufinamide)
   6285605844671
PDPs
245
MAPDs
BANZEL TABLET 400MG
(Rufinamide)
120 BOT6285605835271
PDPs
245
MAPDs
COPEGUS 200MG TABLET
(Ribavirin)
168 BOT0000400869420
PDPs
62
MAPDs
CRESTOR 10MG TABLET
(Rosuvastatin Calcium)
90 BOT0031007519065
PDPs
220
MAPDs
CRESTOR 20MG TABLET
(Rosuvastatin Calcium)
90 BOT0031007529065
PDPs
220
MAPDs
CRESTOR 40mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC
(Rosuvastatin Calcium)
30 TABLET, FILM COATED in  0031007543065
PDPs
220
MAPDs
CRESTOR 5MG TABLET
(Rosuvastatin Calcium)
90 BOT0031007559065
PDPs
219
MAPDs
Daliresp 500ug/1 30 TABLET in 1 BOTTLE, PLASTIC
(ROFLUMILAST)
30 TABLET in 1 BOTTLE, PL  0045600953041
PDPs
144
MAPDs
EDURANT 27.5mg/1
(Rilpivirine)
   5967602780171
PDPs
245
MAPDs
Elitek 3 KIT in 1 CARTON / 1 KIT in 1 KIT
(Rasburicase For IV)
3 KIT in 1 CARTON / 1 KIT  0002451501071
PDPs
242
MAPDs
Evista 60mg/1 100 TABLET in 1 BOTTLE
(Raloxifene HCl)
100 TABLET BOTTLE  0000241650271
PDPs
245
MAPDs
EXELON 1.5MG CAPSULE
(Rivastigmine Tartrate)
60 BOT0007803234418
PDPs
60
MAPDs
EXELON 2MG/ML ORAL SOLUTION
(Rivastigmine Tartrate)
120 ML BOT0007803393163
PDPs
214
MAPDs
EXELON 3MG CAPSULE
(Rivastigmine Tartrate)
60 BOT0007803244418
PDPs
60
MAPDs
EXELON 4.5MG CAPSULE
(Rivastigmine Tartrate)
60 BOT0007803254418
PDPs
60
MAPDs
EXELON 6MG CAPSULE
(Rivastigmine Tartrate)
60 BOT0007803264418
PDPs
60
MAPDs
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS
(Rivastigmine TD)
30 CRTN0007805011564
PDPs
228
MAPDs
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS
(Rivastigmine TD)
30 CRTN0007805021564
PDPs
228
MAPDs
IMOVAX RABIES VACCINE 2.5UNT/ML
(Rabies Virus Vaccine, HDC)
1 ML VIAL4928102505171
PDPs
245
MAPDs
ISENTRESS 400MG TABLET
(Raltegravir Potassium)
60 BOT0000602276171
PDPs
245
MAPDs
ISTODAX KIT
(Romidepsin)
1 PKGCOM 5957209830156
PDPs
197
MAPDs
JAKAFI 10 MG TABLET
(ruxolitinib)
   5088100106071
PDPs
245
MAPDs
JAKAFI 15 MG TABLET
(ruxolitinib)
   5088100156071
PDPs
245
MAPDs
JAKAFI 20 MG TABLET
(ruxolitinib)
   5088100206071
PDPs
245
MAPDs
JAKAFI 25 MG TABLET
(ruxolitinib)
   5088100256071
PDPs
245
MAPDs
JAKAFI 5 MG TABLET
(ruxolitinib)
   5088100056071
PDPs
245
MAPDs
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML
(Measles, Mumps, and Rubella Vaccine)
10 X 0.5 ML VIAL0000646810071
PDPs
245
MAPDs
MAXALT 10MG TABLET 12 CRTN
(Rizatriptan Benzoate)
12 CRTN0000602671259
PDPs
205
MAPDs
MAXALT MLT 10MG TABLET 4X3 UNIT DOSE CASE
(Rizatriptan Benzoate)
4X3 UNIT DOSE CASE0000638011261
PDPs
207
MAPDs
MAXALT 5MG TABLET 12 CRTN
(Rizatriptan Benzoate)
12 CRTN0000602661259
PDPs
205
MAPDs
MAXALT MLT 5MG TABLET 4X3 UNIT CASE
(Rizatriptan Benzoate)
4X3 UNIT CASE0000638001261
PDPs
207
MAPDs
MYCOBUTIN 150MG CAPSULE
(Rifabutin)
100 BOT0001353011771
PDPs
245
MAPDs
NORVIR 100mg/1 30 CAPSULE in 1 BOTTLE
(Ritonavir)
30 CAPSULE in 1 BOTTLE  0007466333071
PDPs
245
MAPDs
NORVIR 100 MG TABLET
(Ritonavir)
30 EA  0007433333071
PDPs
243
MAPDs
NORVIR 80MG/ML ORAL SOLUTION
(Ritonavir)
240 ML BOT0007419406371
PDPs
245
MAPDs
PRANDIMET TABLET
(Metformin and Repaglinide)
100 BOT0016900930122
PDPs
93
MAPDs
PRANDIMET TABLET
(Metformin and Repaglinide)
100 BOT0016900920122
PDPs
93
MAPDs
PRANDIN 0.5MG TABLET
(Repaglinide)
1000 BOT0016900818364
PDPs
226
MAPDs
PRANDIN 1MG TABLET
(Repaglinide)
1000 BOT0016900828364
PDPs
226
MAPDs
PRANDIN 2MG TABLET
(Repaglinide)
1000 BOT0016900848364
PDPs
226
MAPDs
PRIFTIN 150MG TABLET
(Rifapentine)
4 X 8 TABLET POUCHES CRTN0008821000365
PDPs
232
MAPDs
RABIES VACCINE RABAVERT INJECTION 2.5UNT/ML 1 DOSE VIAL
(Rabies Vaccine, PCEC For)
1 DOSE VIAL6385105010171
PDPs
245
MAPDs
RAMIPRIL 1.25MG CAPSULE
(Ramipril)
30 BOT1625205703071
PDPs
239
MAPDs
RAMIPRIL 10MG CAPSULE
(Ramipril)
100 BOT1625205730171
PDPs
240
MAPDs
RAMIPRIL 2.5MG CAPSULE
(Ramipril)
100 BOT1625205710171
PDPs
240
MAPDs
RAMIPRIL 5MG CAPSULE
(Ramipril)
100 BOT1625205720171
PDPs
240
MAPDs
RANEXA 1,000 MG TABLET
(Ranolazine)
60 EA  6195810020170
PDPs
242
MAPDs
RANEXA 500 MG TABLET
(Ranolazine)
60 EA  6195810010170
PDPs
244
MAPDs
Ranitidine 15mg/mL
(Ranitidine)
   6586204317469
PDPs
240
MAPDs
RANITIDINE 150MG CAPSULE
(Ranitidine)
500 BOT0078128550565
PDPs
230
MAPDs
RANITIDINE TABLET USP 150MG (500 CT)
(Ranitidine)
500 BOT6467909060370
PDPs
243
MAPDs
Ranitidine 300mg/1 100 TABLET, FILM COATED in 1 BOTTLE
(Ranitidine)
100 TABLET, FILM COATED i  0017243586071
PDPs
245
MAPDs
Ranitidine Hydrochloride 300mg/1 30 CAPSULE in 1 BOTTLE
(Ranitidine)
30 CAPSULE in 1 BOTTLE  0078128653166
PDPs
231
MAPDs
RANITIDINE HCL 25MG/ML VIAL
(Ranitidine HCl)
6 ML VIALMD CRTN5539006160157
PDPs
220
MAPDs
RAPAFLO CAPSULES 4MG 30 BOT
(Silodosin)
30 BOT5254401513049
PDPs
99
MAPDs
RAPAFLO CAPSULES 8MG 90 BOT
(Silodosin)
90 BOT5254401521949
PDPs
99
MAPDs
RAPAMUNE TABLETS
(Sirolimus)
100 BOT 0000810400571
PDPs
243
MAPDs
RAPAMUNE 1MG TABLET
(Sirolimus)
100 BOT0000810410571
PDPs
245
MAPDs
RAPAMUNE 1MG/ML ORAL TUBEX
(Sirolimus)
60 ML BOT0000810300671
PDPs
245
MAPDs
RAPAMUNE 2MG TABLET
(Sirolimus)
100 BOT0000810420571
PDPs
245
MAPDs
RAZADYNE 12MG TABLET
(Galantamine Hydrobromide)
TABLETS BOT5045803986017
PDPs
49
MAPDs
RAZADYNE SOL 4MG/ML
(Galantamine Hydrobromide)
100 ML BOT5045804901021
PDPs
72
MAPDs
RAZADYNE 4MG TABLET
(Galantamine Hydrobromide)
60 TABLETS BOT5045803966017
PDPs
48
MAPDs
RAZADYNE 8MG TABLET
(Galantamine Hydrobromide)
60 TABLETS BOT5045803976017
PDPs
48
MAPDs
RAZADYNE ER 16MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT5045803883017
PDPs
53
MAPDs
RAZADYNE ER 24MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT5045803893017
PDPs
53
MAPDs
RAZADYNE ER 8MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT5045803873017
PDPs
53
MAPDs
REBETOL 200 MG CAPSULE
(Ribavirin)
70 EA  0008513850724
PDPs
67
MAPDs
REBETOL 40MG/ML SOLUTION
(Ribavirin)
100 ML BOT0008513180153
PDPs
178
MAPDs
REBIF 22ug/0.5mL 12 SYRINGE, GLASS in 1 CARTON / 0.5 mL in 1 SYRINGE, GLASS
(Interferon Beta-1a)
12 SYRINGE, GLASS in 1 CA  4408700220357
PDPs
215
MAPDs
REBIF 44ug/0.5mL 12 SYRINGE, GLASS in 1 CARTON / 0.5 mL in 1 SYRINGE, GLASS
(Interferon Beta-1a)
12 SYRINGE, GLASS in 1 CA  4408700440357
PDPs
204
MAPDs
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL
(Interferon Beta-1a)
   4408788220156
PDPs
213
MAPDs
RECLAST INJECTION
(Zoledronic Acid IV)
100 ML BOT 0007804356133
PDPs
110
MAPDs
RECLIPSEN 0.15-0.03 TABLET
(Desogestrel & Ethinyl Estradiol)
6 X 28 BLPK5254409542865
PDPs
204
MAPDs
RECOMBIVAX HB 40MCG/ML VIAL
(Hepatitis B Vaccine (Recombinant))
1 ML VIALSD0000649920071
PDPs
245
MAPDs
Rectiv 4mg/g 1 TUBE in 1 CARTON / 30 g in 1 TUBE
(Nitroglycerin)
1 TUBE in 1 CARTON / 30 g  4274702353026
PDPs
89
MAPDs
REGLAN 5MG/ML VIAL
(Metoclopramide HCl)
25 X 10 VIALSD6097704510220
PDPs
55
MAPDs
Regonol 5mg/mL 10 AMPULE in 1 CARTON / 2 mL in 1 AMPULE
(Pyridostigmine Bromide)
10 AMPULE in 1 CARTON / 2  0078130409543
PDPs
160
MAPDs
REGRANEX 0.01% GEL
(Becaplermin)
15 GM TUBE0004508101564
PDPs
233
MAPDs
RELENZA 5MG DISKHALER
(Zanamivir Aero)
5 X 4 BLPK0017306810157
PDPs
200
MAPDs
RELISTOR 12 MG/0.6 ML VIAL
(Methylnaltrexone)
   6564905510271
PDPs
244
MAPDs
RELPAX 20MG TABLET
(Eletriptan Hydrobromide)
6 BLPK0004923304542
PDPs
162
MAPDs
RELPAX 40MG TABLET 6X2 BLPK
(Eletriptan Hydrobromide)
6 X 2 BLPK0004923400542
PDPs
162
MAPDs
REMERON 15MG TABLET
(Mirtazapine)
30 BLPK0005201053017
PDPs
62
MAPDs
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN
(Mirtazapine)
30 BLPK CRTN0005201063017
PDPs
64
MAPDs
REMERON 30MG TABLET
(Mirtazapine)
30 BOT0005201073017
PDPs
62
MAPDs
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN
(Mirtazapine)
30 TABS CRTN0005201083017
PDPs
64
MAPDs
REMERON 45MG TABLET
(Mirtazapine)
30 TABLETS BOT0005201093017
PDPs
62
MAPDs
REMERON SLTABLET 45MG TABLET
(Mirtazapine)
30 TABS CRTN0005201103017
PDPs
64
MAPDs
REMICADE 100MG VIAL
(Infliximab For IV)
20 ML VIALSU5789400300171
PDPs
245
MAPDs
REMODULIN 1MG/ML VIAL
(Treprostinil Sodium)
20 VIALMD6630201010156
PDPs
183
MAPDs
REMODULIN 10MG/ML VIAL
(Treprostinil Sodium)
20 VIALMD6630201100156
PDPs
183
MAPDs
REMODULIN 2.5MG/ML VIAL
(Treprostinil Sodium)
20 VIALMD6630201020156
PDPs
184
MAPDs
REMODULIN 5MG/ML VIAL
(Treprostinil Sodium)
20 VIALMD6630201050156
PDPs
183
MAPDs
RENAGEL 400MG TABLET
(Sevelamer HCl)
   5846800200142
PDPs
165
MAPDs
RENAGEL 800MG TABLET
(Sevelamer HCl)
   5846800210142
PDPs
166
MAPDs
RENVELA 800MG TABLET
(Sevelamer Carbonate)
   5846801300171
PDPs
238
MAPDs
REPREXAIN TABLET
(Hydrocodone-Ibuprofen)
100 BOT6371709020136
PDPs
111
MAPDs
REPREXAIN TABLET
(Hydrocodone-Ibuprofen)
100 BOT6371709000121
PDPs
87
MAPDs
REPREXAIN 5-200 MG TABLET 100 EA
(Hydrocodone-Ibuprofen)
   6371709010119
PDPs
85
MAPDs
REQUIP 0.25MG TABLET
(Ropinirole HCL)
100 BOT0000748902017
PDPs
49
MAPDs
REQUIP 0.5MG TABLET
(Ropinirole HCL)
100 BOT0000748912017
PDPs
49
MAPDs
REQUIP 1MG TABLET
(Ropinirole HCL)
100 BOT0000748922017
PDPs
49
MAPDs
REQUIP XL TABLET 12 MG
(Ropinirole HCL)
30 BOT0000748821334
PDPs
103
MAPDs
REQUIP 2MG TABLET
(Ropinirole HCL)
100 BOT0000748932017
PDPs
49
MAPDs
REQUIP XL 2mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE
(Ropinirole HCL)
30 TABLET, FILM COATED, E  0000748851334
PDPs
104
MAPDs
REQUIP 3MG TABLET
(Ropinirole HCL)
100 BOT0000748952017
PDPs
49
MAPDs
REQUIP 4MG TABLET
(Ropinirole HCL)
100 BOT0000748962017
PDPs
49
MAPDs
REQUIP XL 4mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE
(Ropinirole HCL)
30 TABLET, FILM COATED, E  0000748871334
PDPs
104
MAPDs
REQUIP 5MG TABLET
(Ropinirole HCL)
100 BOT0000748942017
PDPs
49
MAPDs
REQUIP XL 6mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE
(Ropinirole Hydrochloride)
30 TABLET, FILM COATED, E  0000748831334
PDPs
102
MAPDs
REQUIP XL 8mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE
(Ropinirole HCL)
30 TABLET, FILM COATED, E  0000748881334
PDPs
104
MAPDs
RESCRIPTOR 100mg/1 360 TABLET in 1 BOTTLE
(Delavirdine Mesylate)
360 TABLET in 1 BOTTLE  4970202092471
PDPs
245
MAPDs
RESCRIPTOR 200mg/1 180 TABLET in 1 BOTTLE
(Delavirdine Mesylate)
180 TABLET in 1 BOTTLE  4970202101770
PDPs
244
MAPDs
RESERPINE 0.1MG TABLET
(Reserpine)
1000 BOTPL0018500321047
PDPs
151
MAPDs
RESERPINE 0.25MG TABLET
(Reserpine)
1000 BOTPL0018501341046
PDPs
153
MAPDs
RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU
(Cyclosporine (Ophth))
30 X 0.4 ML VIALSU0002391633071
PDPs
245
MAPDs
RETIN-A 0.01% GEL
(Tretinoin)
45 GM TUBE0006205754617
PDPs
47
MAPDs
RETIN-A 0.025% GEL
(Tretinoin)
45 GM TUBE0006204754517
PDPs
47
MAPDs
RETIN-A 0.025% CREAM
(Tretinoin)
45 GRAMS TUBE0006201650217
PDPs
47
MAPDs
RETIN-A 0.05% CREAM
(Tretinoin)
45 GM TUBE0006201751317
PDPs
47
MAPDs
RETIN A CREAM
(Tretinoin)
20 GM TUBE 0006202752317
PDPs
47
MAPDs
RETIN-A MICRO 0.04% GEL
(Tretinoin Microsphere)
45 GM TUBE0006202040327
PDPs
111
MAPDs
RETIN-A MICRO 0.1% GEL
(Tretinoin Microsphere)
45 GM TUBE0006201900326
PDPs
110
MAPDs
RETROVIR 10mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 20 mL in 1 VIAL, SINGLE-USE
(Zidovudine)
10 VIAL, SINGLE-USE in 1  4970202130571
PDPs
245
MAPDs
RETROVIR 100mg/1 100 CAPSULE in 1 BOTTLE
(Zidovudine)
100 CAPSULE BOTTLE  4970202112022
PDPs
70
MAPDs
RETROVIR 300mg/1 60 TABLET, FILM COATED in 1 BOTTLE
(Zidovudine)
60 TABLET, FILM COATED in  4970202141822
PDPs
70
MAPDs
RETROVIR 50mg/5mL 240 mL in 1 BOTTLE
(Zidovudine)
240 mL in 1 BOTTLE  4970202124822
PDPs
72
MAPDs
Revatio 0.8mg/mL 12.5 mL in 1 VIAL, SINGLE-USE
(Sildenafil Citrate)
12.5 mL in 1 VIAL, SINGLE  0006903380134
PDPs
110
MAPDs
REVATIO 20MG TABLET
(Sildenafil Citrate)
90 BOT0006941906868
PDPs
242
MAPDs
REVIA 50MG TABLET
(Naltrexone HCl)
30 BOT5128502750119
PDPs
54
MAPDs
REVLIMID 10MG CAPSULE (100 CT)
(Lenalidomide)
100 BOT5957204100071
PDPs
245
MAPDs
REVLIMID 15MG CAPSULE 21 BOT
(Lenalidomide)
21 BOT5957204152171
PDPs
244
MAPDs
REVLIMID 25MG CAPSULE (100 CT)
(Lenalidomide)
100 BOT5957204250071
PDPs
244
MAPDs
REVLIMID 5MG CAPSULE
(Lenalidomide)
100 BOT5957204050071
PDPs
245
MAPDs
REYATAZ 100MG CAPSULE
(Atazanavir Sulfate)
60 BOT0000336231271
PDPs
245
MAPDs
REYATAZ 150MG CAPSULE
(Atazanavir Sulfate)
100 BOT0000336241271
PDPs
245
MAPDs
REYATAZ 200MG CAPSULE
(Atazanavir Sulfate)
100 BOT0000336311271
PDPs
245
MAPDs
REYATAZ 300MG CAPSULE
(Atazanavir Sulfate)
30 BOT0000336221271
PDPs
244
MAPDs
RHEUMATREX 2.5MG TABLET DOSE PACK
(Methotrexate Sodium)
   6725305804637
PDPs
130
MAPDs
RHINOCORT AQUA NASAL SPRAY 32 MCG/SPRAY
(Budesonide Nasal)
1 X 8.6 GM CTR0018610700831
PDPs
129
MAPDs
RIBASPHERE RibaPak 600mg/1
(Ribavirin)
   6643501079952
PDPs
194
MAPDs
RIBASPHERE RibaPak
(Ribavirin)
   6643501069949
PDPs
185
MAPDs
RIBASPHERE 200MG TABLET
(Ribavirin)
168 BOT6643501021669
PDPs
224
MAPDs
RIBASPHERE CAPSULES 200MG 42 BOT
(Ribavirin)
42 BOT6643501014264
PDPs
221
MAPDs
RIBASPHERE RibaPak 400mg/1
(Ribavirin)
   6643501059954
PDPs
194
MAPDs
RIBASPHERE 400MG TABLET
(Ribavirin)
56 BOT6643501035659
PDPs
205
MAPDs
RIBASPHERE 600MG TABLET
(Ribavirin)
56 BOT6643501045657
PDPs
204
MAPDs
RIBAVIRIN 200MG TABLET 168 BOT
(Ribavirin)
168 BOT6838200460371
PDPs
238
MAPDs
RIBAVIRIN 200MG CAPSULE
(Ribavirin)
70 CAPSULES BOT0009372277768
PDPs
239
MAPDs
RIDAURA 3MG CAPSULE
(Auranofin)
60 BOT6548300930656
PDPs
180
MAPDs
RIFADIN 150MG CAPSULE
(Rifampin)
30 BOT0006805103019
PDPs
56
MAPDs
RIFADIN 300MG CAPSULE
(Rifampin)
100 BOT0006805086118
PDPs
55
MAPDs
RIFADIN IV 600MG VIAL
(Rifampin)
600 MG VIAL0006805970122
PDPs
63
MAPDs
RIFAMATE CAPSULE
(Isoniazid & Rifampin)
60 BOT0006805096020
PDPs
63
MAPDs
RIFAMPIN 150MG CAPSULE (30 CT)
(Rifampin)
30 BOTPL0018508013071
PDPs
245
MAPDs
RIFAMPIN 300MG CAPSULE
(Rifampin)
60 CAPSULES BOTPL0018507996071
PDPs
245
MAPDs
RIFAMPIN 600MG VIAL
(Rifampin)
1 VIL CRTN5539001230171
PDPs
245
MAPDs
RIFATER TABLET
(Isoniazid-Rifampin w/ Pyrazinamide)
60 BOT0008805764135
PDPs
128
MAPDs
RILUTEK 50MG TABLET
(Riluzole)
60 BOTPL0007577006071
PDPs
245
MAPDs
RIMANTADINE 100MG TABLET
(Rimantadine)
100 BOT0078150290171
PDPs
245
MAPDs
RINGERS INJECTION 1000ML BAG
(Ringers)
1000 ML BAG0026477800056
PDPs
204
MAPDs
RINGERS IRRIGATION 860-30 12X1000ML BAG
(Ringers)
12 X 1000 ML BAG0040961400935
PDPs
132
MAPDs
RIOMET 500MG/5ML SOLUTION ORAL
(Metformin HCl)
473 ML BOT1063102060233
PDPs
106
MAPDs
RISPERDAL M TABLET 0.5MG
(Risperidone)
7 CARDS OF 4 BLPK5045803952818
PDPs
78
MAPDs
RISPERDAL 0.25MG TABLET
(Risperidone)
500 BOT5045803015015
PDPs
61
MAPDs
RISPERDAL 0.5MG TABLET
(Risperidone)
500 BOT5045803025015
PDPs
61
MAPDs
RISPERDAL 1MG/ML SOLUTION
(Risperidone)
30 ML BOT5045803050319
PDPs
68
MAPDs
RISPERDAL 1MG TABLET
(Risperidone)
500 BOT5045803005015
PDPs
61
MAPDs
RISPERDAL 1MG M-TAB
(Risperidone)
7 CARDS OF 4 TABLETS BLPK5045803152818
PDPs
82
MAPDs
RISPERDAL 2MG TABLET
(Risperidone)
500 BOT5045803205015
PDPs
61
MAPDs
RISPERDAL M-TAB 2mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK
(Risperidone)
7 BLISTER PACK in 1 BOX /  5045803252818
PDPs
78
MAPDs
RISPERDAL 3MG TABLET
(Risperidone)
500 BOT5045803305015
PDPs
61
MAPDs
RISPERDAL M-TAB 3mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK
(Risperidone)
7 BLISTER PACK in 1 BOX /  5045803352818
PDPs
77
MAPDs
RISPERDAL 4MG TABLET
(Risperidone)
60 BOT5045803500615
PDPs
61
MAPDs
RISPERDAL M-TAB 4mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK
(Risperidone)
7 BLISTER PACK in 1 BOX /  5045803552818
PDPs
77
MAPDs
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL
(Risperidone Microspheres For)
12.5 MG VIAL DSPK5045803091168
PDPs
238
MAPDs
RISPERDAL CONSTA 25MG SYR
(Risperidone Microspheres For)
25 MG VIAL DSPK5045803061171
PDPs
245
MAPDs
RISPERDAL CONSTA 37.5MG SYR
(Risperidone Microspheres For)
37.5 MG VIAL DSPK5045803071171
PDPs
244
MAPDs
RISPERDAL CONSTA 50MG SYR
(Risperidone Microspheres For)
50 MG VIAL DSPK5045803081171
PDPs
245
MAPDs
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK
(Risperidone)
4 IN 1 BLPK4988402125568
PDPs
235
MAPDs
RISPERIDONE TABLET
(Risperidone)
60 TABS BOT0009302210671
PDPs
245
MAPDs
RISPERIDONE TABLETS ORALLY DISINTEGRATING 0.5MG 30 BLPK
(Risperidone)
30 BLPK5511102078170
PDPs
239
MAPDs
Risperidone 1mg/mL 30 mL in 1 BOTTLE
(Risperidone)
30 mL in 1 BOTTLE  5511105793071
PDPs
245
MAPDs
RISPERIDONE TABLET 1 MG
(Risperidone)
60 TABS BOT0009372400671
PDPs
245
MAPDs
Risperidone 1mg/1 7 BLISTER PACK in 1 CARTON / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK
(Risperidone)
7 BLISTER PACK in 1 CARTO  4988403159170
PDPs
239
MAPDs
RISPERIDONE TABLETS ORALLY DISINTEGRATING 2MG 30 BLPK
(Risperidone)
30 BLPK5511102098170
PDPs
240
MAPDs
RISPERIDONE TABLET 2 MG
(Risperidone)
60 TAB BOT0009372410671
PDPs
245
MAPDs
RISPERIDONE TABLETS 3MG 4 IN 1 BLPK
(Risperidone)
4 IN 1 BLPK4988404029170
PDPs
239
MAPDs
RISPERIDONE TABLET 3 MG
(Risperidone)
60 TAB BOT0009372420671
PDPs
245
MAPDs
RISPERIDONE TABLETS 4MG 4 IN 1 BLPK
(Risperidone)
4 IN 1 BLPK4988404039170
PDPs
239
MAPDs
RISPERIDONE TABLET 4 MG
(Risperidone)
60 TAB BOT0009372430671
PDPs
245
MAPDs
RISPERIODONE TABLET
(RISPERIODONE)
60 TAB BOT0009302250671
PDPs
245
MAPDs
RITALIN 10MG TABLET
(Methylphenidate HCl)
100 BOT0007804400516
PDPs
62
MAPDs
RITALIN 20MG TABLET
(Methylphenidate HCl)
100 BOT0007804410516
PDPs
62
MAPDs
RITALIN-SR 20MG TABLET SA
(Methylphenidate HCl)
100 BOT0007804420516
PDPs
61
MAPDs
RITALIN 5MG TABLET
(Methylphenidate HCl)
100 BOT0007804390516
PDPs
62
MAPDs
RITALIN LA 10MG CAPSULE
(Methylphenidate HCl)
100 BOT0007804240532
PDPs
115
MAPDs
RITALIN LA 20MG CAPSULE
(Methylphenidate HCl)
100 BOT0007803700525
PDPs
87
MAPDs
RITALIN LA 30MG CAPSULE
(Methylphenidate HCl)
100 BOT0007803710525
PDPs
87
MAPDs
RITALIN LA 40MG CAPSULE
(Methylphenidate HCl)
100 BOT0007803720525
PDPs
87
MAPDs
RITUXAN 10MG/ML VIAL
(Rituximab For IV)
1 X 50 ML VIAL CRTN5024200530671
PDPs
244
MAPDs
RIVASTIGMINE TARTRATE CAPSULES
(Rivastigmine Tartrate)
60 BOT 0059132086071
PDPs
221
MAPDs
RIVASTIGMINE TARTRATE CAPSULES
(Rivastigmine Tartrate)
60 BOT 0059132096071
PDPs
221
MAPDs
RIVASTIGMINE TARTRATE CAPSULES
(Rivastigmine Tartrate)
60 BOT 0059132106071
PDPs
221
MAPDs
RIVASTIGMINE TARTRATE CAPSULES
(Rivastigmine Tartrate)
60 BOT 0059132116071
PDPs
221
MAPDs
ROBAXIN 100MG/ML VIAL
(Methocarbamol)
25 X 10ML VIALSD6097701500128
PDPs
111
MAPDs
ROBAXIN 500 MG TABLET
(Methocarbamol)
100 EA  5224404291016
PDPs
59
MAPDs
ROBINUL 0.2MG/ML VIAL
(Glycopyrrolate)
25 X 5ML VIALMD6097701550318
PDPs
62
MAPDs
ROBINUL 1MG TABLET
(Glycopyrrolate)
100 TABS BOTPL5963002001018
PDPs
67
MAPDs
ROBINUL FORTE 2MG TABLET
(Glycopyrrolate)
100 TABS BOTPL5963002051018
PDPs
67
MAPDs
Rocaltrol 0.25ug GELATIN COATED 100 CAPSULE BOTTLE
(Calcitriol)
100 CAPSULE BOTTLE  3069801430117
PDPs
65
MAPDs
Rocaltrol 0.5ug GELATIN COATED 100 CAPSULE BOTTLE
(Calcitriol)
100 CAPSULE BOTTLE  3069801440117
PDPs
65
MAPDs
Rocaltrol 1ug/mL 15 mL in 1 BOTTLE
(Calcitriol)
15 mL in 1 BOTTLE  3069809111517
PDPs
67
MAPDs
ROCEPHIN FOR INJECTION
(Ceftriaxone Sodium For)
1 VIALGL BOX 0000419630223
PDPs
71
MAPDs
ROMYCIN 5MG/G OINTMENT
(Erythromycin Ophth)
3.5 GM TUBE5479905403568
PDPs
219
MAPDs
ROPINIROLE TAB 12MG ER
(Ropinirole)
   0022836610345
PDPs
140
MAPDs
ROPINIROLE TAB 2MG ER
(Ropinirole)
   0022836580946
PDPs
141
MAPDs
ROPINIROLE TAB 4MG ER
(Ropinirole)
   0022836590345
PDPs
140
MAPDs
ROPINIROLE TAB 6MG ER
(Ropinirole)
   0022836400345
PDPs
140
MAPDs
ROPINIROLE TAB 8MG ER
(Ropinirole)
   0022836600345
PDPs
140
MAPDs
ROPINIROLE HYDROCLORIDE TABLET
(Ropinirole HCL)
100 BOT0037855250171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET
(Ropinirole HCL)
100 BOT0037855500171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET 1 MG
(Ropinirole HCL)
100 BOT0037855010171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET 2 MG
(Ropinirole HCL)
100 BOT0037855020171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET 3 MG
(Ropinirole HCL)
100 BOT0037855030171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET 4 MG
(Ropinirole HCL)
100 BOT0037855040171
PDPs
245
MAPDs
ROPINIROLE HCL TABLET 5 MG
(Ropinirole HCL)
100 BOT0037855050171
PDPs
245
MAPDs
ROTATEQ VACCINE
(Rotavirus Vaccine, Live Oral Pentavalent)
10 X 2 ML TUBE0000640474171
PDPs
245
MAPDs
sF Rowasa 4g/60mL
(Mesalamine)
   6822000222814
PDPs
68
MAPDs
Roxicet 325; 5mg 100 TABLET BOTTLE
(Oxycodone w/ Acetaminophen)
100 TABLET BOTTLE  0005446502564
PDPs
222
MAPDs
ROXICET 5-325/5ML SOLUTION ORAL
(Oxycodone w/ Acetaminophen)
500 ML BOT0005436866348
PDPs
187
MAPDs
ROXICET 5/500 CAPLET
(Oxycodone w/ Acetaminophen)
100 BOT0005447842535
PDPs
137
MAPDs
ROXICODONE 15MG TABLET
(Oxycodone HCl)
100 BOT6647905811017
PDPs
62
MAPDs
ROXICODONE 30MG TABLET
(Oxycodone HCl)
100 BOT6647905821017
PDPs
62
MAPDs
ROXICODONE TABLETS 5 MG
(Oxycodone HCl)
25 BLPK6647905802518
PDPs
59
MAPDs
ROZEREM 8MG TABLET (100 CT)
(Ramelteon)
100 BOT6476408051030
PDPs
122
MAPDs
RYTHMOL TABLETS
(Propafenone HCl)
100 BOT 0017307922016
PDPs
61
MAPDs
RYTHMOL FILM COATED TABLETS 225 MG
(Propafenone HCl)
100 BOT0017307942016
PDPs
61
MAPDs
RYTHMOL SR 325mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE
(Propafenone HCl)
60 CAPSULE, EXTENDED RELE  0017308241820
PDPs
77
MAPDs
RYTHMOL SR 225mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE
(Propafenone HCl)
60 CAPSULE, EXTENDED RELE  0017308231820
PDPs
77
MAPDs
RYTHMOL SR 425mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE
(Propafenone HCl)
60 CAPSULE, EXTENDED RELE  0017308261820
PDPs
77
MAPDs
RYZOLT EXTENDED RELEASE TABLETS 100MG 30 BOT
(Tramadol HCl extended release)
30 BOT5901103343015
PDPs
56
MAPDs
RYZOLT EXTENDED RELEASE TABLETS 200MG 30 BOT
(Tramadol HCl extended release)
30 BOT5901103353015
PDPs
56
MAPDs
RYZOLT EXTENDED RELEASE TABLETS 300MG 30 BOT
(Tramadol HCl extended release)
30 BOT5901103363015
PDPs
57
MAPDs
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA]
(Sevelamer Carbonate)
   5846801310268
PDPs
211
MAPDs
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA]
(Sevelamer Carbonate)
   5846801320265
PDPs
189
MAPDs
TIS-U-SOL IRRIGATION SOLUTION
(Ringers)
1000 ML BOTPL0033801900430
PDPs
84
MAPDs
VEXOL 1% EYE DROPS
(Rimexolone Ophth)
10 ML BOTPL0006506270332
PDPs
108
MAPDs
VIRAZOLE 6GM VIAL
(Ribavirin For)
6 GM VIAL0018700071431
PDPs
89
MAPDs
Xarelto 10mg/1 10 BLISTER PACK in 1 CARTON / 10 TABLET in 1 BLISTER PACK
(rivaroxaban)
10 BLISTER PACK in 1 CART  5045805801065
PDPs
193
MAPDs
XARELTO 15 MG TABLET
(rivaroxaban)
100 EA  5045805781060
PDPs
187
MAPDs
XARELTO 20 MG TABLET
(rivaroxaban)
100 EA  5045805791060
PDPs
187
MAPDs
XIFAXAN 200MG TABLET
(Rifaximin)
30 BOT6564903010341
PDPs
144
MAPDs
XIFAXAN TABLETS
(Rifaximin)
10 X 6 BLPK CRTN 6564903030353
PDPs
192
MAPDs
ZANTAC 15MG/ML SYRUP
(Ranitidine HCl)
16 FLO BOT0017303835418
PDPs
52
MAPDs
ZANTAC 150MG TABLET
(Ranitidine HCl)
500 BOT0017303441416
PDPs
49
MAPDs
ZANTAC 25MG/ML VIAL
(Ranitidine HCl)
6 ML VIALMD0017303630119
PDPs
54
MAPDs
ZANTAC 25 EFFERDOSE TABLET
(Ranitidine HCl)
60 CRTN0017307340021
PDPs
65
MAPDs
ZANTAC 300MG TABLET
(Ranitidine HCl)
30 BOT0017303934017
PDPs
50
MAPDs
ZANTAC 50MG/50ML PLAST-BAG
(Ranitidine HCl)
24 X 50ML CTR0017304410028
PDPs
82
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data )




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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.