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2017 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:

Drug Names Containing the Letter I 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 2017 Formularies
PDPsMAPDs
ABSORICA 10 MG CAPSULE
(Isotretinoin)
   106310115312
PDPs
23
MAPDs
ABSORICA 20 MG CAPSULE
(Isotretinoin)
   106310116312
PDPs
23
MAPDs
ABSORICA 25 MG CAPSULE
(Isotretinoin)
   106310133312
PDPs
28
MAPDs
ABSORICA 30 MG CAPSULE
(Isotretinoin)
   106310117312
PDPs
23
MAPDs
ABSORICA 35 MG CAPSULE
(Isotretinoin)
   106310134312
PDPs
28
MAPDs
ABSORICA 40 MG CAPSULE
(Isotretinoin)
   106310118312
PDPs
23
MAPDs
ACTIMMUNE 100 MCG/0.5 ML VIAL
(Interferon Gamma-1B)
.5 ML  4223801110159
PDPs
341
MAPDs
AFREZZA 30-4 UNIT + 60-8 UNIT
(insulin)
   479180882365
PDPs
48
MAPDs
AFREZZA 4 UNITS CARTRIDGE INH
(insulin)
   479180874905
PDPs
48
MAPDs
AFREZZA 4 UNIT/8 UNIT/12 UNIT
(insulin)
   479180902185
PDPs
48
MAPDs
AFREZZA 60-4 UNIT + 30-8 UNIT
(insulin)
   479180884635
PDPs
48
MAPDs
AFREZZA 60-8 UNIT + 30-12 UNIT
(insulin)
   479180894635
PDPs
48
MAPDs
AFREZZA 90-4 UNIT / 90-8 UNIT
(insulin)
   479180880185
PDPs
48
MAPDs
IPRATROPIUM BROMIDE and ALBUTEROL SULFATE 2.5; 0.5mg/3mL; mg/3mL 6 POUCH per CARTON / 5 VIAL, PLAS
(Albuterol-Ipratropium Nebu)
6 POUCH in 1 CARTON / 5 V  0009367237347
PDPs
275
MAPDs
ALDARA 5% CREAM
(Imiquimod)
   992070260125
PDPs
11
MAPDs
APIDRA 100 UNITS/ML VIAL
(Insulin Glulisine Subcutaneous)
10 ML  000882500335
PDPs
78
MAPDs
Arcapta Neohaler 75ug/1 30 BLISTER PACK in 1 BOX / 1 CAPSULE per BLISTER PACK
(INDACATEROL MALEATE)
30 BLISTER PACK in 1 BOX  0007806191512
PDPs
107
MAPDs
ATROVENT HFA AER 17MCG
(Ipratropium Bromide HFA)
12.9 GRAMS PER 200 ACT CAN0059700871755
PDPs
326
MAPDs
AVALIDE 150-12.5 MG TABLET
(Irbesartan-Hydrochlorothiazide)
90 EA  000245855906
PDPs
11
MAPDs
AVALIDE 300-12.5 MG TABLET
(Irbesartan-Hydrochlorothiazide)
30 EA  000245856306
PDPs
11
MAPDs
AVAPRO 150 MG TABLET
(Irbesartan)
30 EA  000245851306
PDPs
11
MAPDs
AVAPRO 300 MG TABLET
(Irbesartan)
90 EA  000245852906
PDPs
11
MAPDs
AVAPRO 75 MG TABLET
(Irbesartan)
90 EA  000245850906
PDPs
11
MAPDs
AVONEX PREFILLED SYR 30 MCG KT
(INTERFERON BETA-1A)
1 EA  5962702220535
PDPs
258
MAPDs
AVONEX ADMIN PACK 30 MCG VL
(INTERFERON BETA-1A/ALBUMIN)
4 EA  5962701110335
PDPs
264
MAPDs
AVONEX PEN 30 MCG/0.5 ML KIT
(INTERFERON BETA-1A)
1 EA  5962703330435
PDPs
258
MAPDs
BASAGLAR 100 UNIT/ML KWIKPEN
(Insulin glargine)
   000027715012
PDPs
28
MAPDs
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM
(Interferon Beta-1b For)
14 TRAY BOX PKGCOM5041905233549
PDPs
298
MAPDs
BIDIL TABLET
(Isosorbide Dinitrate-Hydralazine HCl)
180 EA  2433800101824
PDPs
145
MAPDs
BIVIGAM LIQUID 10% VIAL
(immune globulin intravenous)
   5973065030134
PDPs
194
MAPDs
BONIVA 150MG TABLET
(Ibandronate Sodium)
3 CRTN000040186822
PDPs
11
MAPDs
BONIVA 3mg/3mL SYRINGE
(Ibandronate Sodium)
1 SYRINGE, GLASS in 1 CAR  0000401910911
PDPs
26
MAPDs
Camptosar 20mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 5 mL in 1 VIAL, SINGLE-DOSE
(Irinotecan HCl)
1 VIAL, SINGLE-DOSE in 1  000097529032
PDPs
34
MAPDs
CARIMUNE NF 6GM VIAL
(Immune Globulin (Human) IV)
6 GM PKGCOM4420604170635
PDPs
247
MAPDs
CEREZYME 400 UNITS VIAL
(Imiglucerase For)
   5846846630159
PDPs
337
MAPDs
CLARAVIS 10 MG CAPSULE
(Isotretinoin)
100 BLPK0055510545653
PDPs
288
MAPDs
CLARAVIS 20 MG CAPSULE
(Isotretinoin)
100 BLPK0055510555655
PDPs
288
MAPDs
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK
(Isotretinoin)
3 BLISTER PACK in 1 CARTO  0055510568655
PDPs
286
MAPDs
CLARAVIS 40MG CAPSULE
(Isotretinoin)
100 BLPK0055510575655
PDPs
288
MAPDs
CORLANOR 5 MG TABLET
(IVABRADINE HYDROCHLORIDE)
60 EA  5551308006025
PDPs
189
MAPDs
CORLANOR 7.5 MG TABLET
(IVABRADINE HYDROCHLORIDE)
60 EA  5551308106025
PDPs
189
MAPDs
CRESEMBA 186 MG CAPSULE
(Isavuconazonium Sulfate)
   0046905201425
PDPs
132
MAPDs
CRESEMBA 372 MG VIAL
(Isavuconazonium Sulfate)
   0046904209925
PDPs
132
MAPDs
CRIXIVAN 200MG CAPSULE
(Indinavir Sulfate)
360 BOT0000605714359
PDPs
341
MAPDs
CRIXIVAN 400mg, 180 CAPSULE BOTTLE
(Indinavir Sulfate)
180 CAPSULE in 1 BOTTLE  0000605736259
PDPs
341
MAPDs
DUEXIS 26.6; 800mg/1; mg/1
(IBUPROFEN AND FAMOTIDINE)
   759870010033
PDPs
25
MAPDs
ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS
(Idursulfase)
1 VIAL, GLASS in 1 BOX /  5409207000136
PDPs
248
MAPDs
EXTAVIA 15 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK
(Interferon Beta-1b For)
15 BLISTER PACK in 1 CART  0007805691218
PDPs
149
MAPDs
FANAPT 4 MG TABLET
(ILOPERIDONE)
60 EA  4306801040257
PDPs
341
MAPDs
FANAPT TITR TABLETS
(ILOPERIDONE)
8 EA  4306801130459
PDPs
336
MAPDs
FANAPT 1 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801010259
PDPs
341
MAPDs
FANAPT 10 MG TABLET
(ILOPERIDONE)
60 EA  4306801100259
PDPs
341
MAPDs
FANAPT 12 MG TABLET
(ILOPERIDONE)
   4306801120259
PDPs
341
MAPDs
FANAPT 2 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801020259
PDPs
341
MAPDs
FANAPT 6 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801060259
PDPs
341
MAPDs
FANAPT 8 MG TABLET
(ILOPERIDONE)
60 EA  4306801080259
PDPs
341
MAPDs
Firazyr 30.0mg/3mL 1 SYRINGE, GLASS per CARTON / 3 mL in 1 SYRINGE, GLASS
(ICATIBANT ACETATE)
1 SYRINGE, GLASS in 1 CAR  5409207020259
PDPs
341
MAPDs
FLEBOGAMMA DIF INJECTION
(Immune Globulin (Human) IV)
   6195300050129
PDPs
219
MAPDs
GamaSTAN S/D 0.165g/mL
(Immune Globulin (Human))
   1353306351242
PDPs
261
MAPDs
GAMASTAN S-D 10 ML
(Immune Globulin (Human))
   1353306351336
PDPs
240
MAPDs
GAMASTAN S-D 2 ML
(Immune Globulin (Human))
   1353306354036
PDPs
240
MAPDs
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS
(Immune Globulin (Human) IV)
1 BOTTLE, GLASS in 1 CART  0094427000333
PDPs
270
MAPDs
GAMMAGARD S-D 10 G (IGA<1) SOL
(Immune Globulin (Human) IV)
   0094426580433
PDPs
241
MAPDs
GAMMAGARD S-D 5 G (IGA<1) SOLN
(Immune Globulin (Human) IV)
   0094426560333
PDPs
241
MAPDs
GAMMAKED 1 GRAM/10 ML VIAL
(Immune Globulin)
10 ML  7612509000130
PDPs
197
MAPDs
GAMMAPLEX 10 GRAM/100 ML VIAL
(immune globulin)
   6420882350640
PDPs
241
MAPDs
GAMMAPLEX 20 GRAM/200 ML VIAL
(immune globulin)
   6420882350340
PDPs
241
MAPDs
GAMMAPLEX INJECTION 5 GM/100 ML
(Immune Globulin)
   6420882340344
PDPs
253
MAPDs
GAMMAPLEX 5 GRAM/50 ML VIAL
(immune globulin)
   6420882350542
PDPs
246
MAPDs
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS
(Immune Globulin (Human) IV)
10 mL in 1 VIAL, GLASS  1353308001244
PDPs
292
MAPDs
GLEEVEC 100MG TABLET (90 CT)
(Imatinib Mesylate)
90 BOT0007804013412
PDPs
114
MAPDs
GLEEVEC 400 MG TABLET
(Imatinib Mesylate)
30 EA  0007806493012
PDPs
114
MAPDs
Humalog 100[iU]/mL 1 VIAL in 1 CARTON / 3 mL in 1 VIAL
(Insulin Lispro (Human))
1 VIAL in 1 CARTON / 3 mL  0000275101738
PDPs
208
MAPDs
HUMALOG 100 UNITS/ML CARTRIDGE
(Insulin Lispro (Human))
3 ML  0000275165938
PDPs
200
MAPDs
HUMALOG KWIKPEN INJECTION
(Insulin Lispro (Human))
3 ML X 5 SYR CRTN 0000287995938
PDPs
204
MAPDs
HUMALOG MIX 50/50 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10 ML VIAL0000275120138
PDPs
209
MAPDs
HUMALOG MIX 75/25 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10ML VIAL0000275110138
PDPs
209
MAPDs
HUMALOG MIX KWIKPEN INJECTION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 0000287985938
PDPs
206
MAPDs
HUMALOG MIX KWIKPEN INJECTION SUSPENSION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 0000287975938
PDPs
206
MAPDs
HUMALOG 200 UNITS/ML KWIKPEN
(Insulin Lispro (Human))
   0000277122738
PDPs
202
MAPDs
HUMULIN 70/30 VIAL
(Insulin Isophane & Regular (Human))
1 X 10 ML VIAL0000287150138
PDPs
205
MAPDs
HUMULIN 70-30 PEN
(Insulin Isophane & Regular (Human))
   0000288030136
PDPs
203
MAPDs
HUMULIN N 100 UNITS/ML PEN
(Insulin Isophane (Human))
   0000288050136
PDPs
203
MAPDs
HUMULIN N 100U/ML VIAL
(Insulin Isophane (Human))
10 ML VIAL0000283150138
PDPs
206
MAPDs
HUMULIN R 100U/ML VIAL
(Insulin Regular (Human))
1 X 10 ML VIAL0000282150138
PDPs
212
MAPDs
HUMULIN R 500 UNITS/ML KWIKPEN
(Insulin Regular (Human))
   0000288242751
PDPs
278
MAPDs
HUMULIN R 500U/ML VIAL
(Insulin Regular (Human))
1 X 20 ML VIAL0000285010155
PDPs
299
MAPDs
IBANDRONATE SODIUM 150 MG TABLET [Boniva]
(Ibandronate Sodium)
   6050527950047
PDPs
281
MAPDs
IBANDRONATE 3 MG/3 ML VIAL [Boniva]
(Ibandronate Sodium)
   6275602184030
PDPs
234
MAPDs
IBRANCE 100 MG CAPSULE
(Palbociclib)
21 EA  0006901882159
PDPs
341
MAPDs
IBRANCE 125 MG CAPSULE
(Palbociclib)
21 EA  0006901892159
PDPs
341
MAPDs
IBRANCE 75 MG CAPSULE
(Palbociclib)
21 EA  0006901872159
PDPs
341
MAPDs
IBUDONE 10; 200mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC
(Hydrocodone Bitartrate and Ibuprofen)
100 TABLET, FILM COATED i  509910579012
PDPs
23
MAPDs
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE
(Ibuprofen)
473 mL in 1 BOTTLE  4580209524357
PDPs
323
MAPDs
IBUPROFEN 400MG TABLETS
(Ibuprofen)
100 BOXUD 0090458536159
PDPs
341
MAPDs
IBUPROFEN 600mg/1 500 TABLET BOTTLE
(Ibuprofen)
500 TABLET BOTTLE  5374604650559
PDPs
341
MAPDs
Ibuprofen 800mg/1 100 TABLET BOTTLE
(Ibuprofen)
100 TABLET in 1 BOTTLE  5374604660159
PDPs
341
MAPDs
ICLUSIG 15 MG TABLET
(ponatinib)
30 EA  7618905353059
PDPs
341
MAPDs
ICLUSIG 45 MG TABLET
(ponatinib)
30 EA  7618905343059
PDPs
341
MAPDs
IDAMYCIN PFS 1MG/ML VIAL
(Idarubicin HCl IV)
20 ML VIALPL000132596914
PDPs
37
MAPDs
IDARUBICIN HCL 1MG/ML VIAL
(Idarubicin HCl IV)
1 X 10 ML PKG0070341551150
PDPs
276
MAPDs
IFEX 1g/1 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE
(Ifosfamide For)
1 INJECTION, POWDER, FOR  003383991011
PDPs
24
MAPDs
IFOSFAMIDE FOR INFECTION 1 GM
(Ifosfamide For)
01 X 1 GM VIALSD6332301421051
PDPs
305
MAPDs
Ilaris 150mg/mL 1 VIAL, SINGLE-USE per CARTON / 1 mL in 1 VIAL, SINGLE-USE
(CANAKINUMAB)
1 VIAL, SINGLE-USE in 1 C  0007805826140
PDPs
256
MAPDs
ILEVRO 0.3% OPHTH DROPS
(nepafenac Dosage)
1.7 ML  0006517500752
PDPs
264
MAPDs
IMATINIB MESYLATE 100 MG TABLET [Gleevec]
(Imatinib Mesylate)
90 EA  4733504728156
PDPs
301
MAPDs
IMATINIB MESYLATE 400 MG TABLET [Gleevec]
(Imatinib Mesylate)
30 EA  4733504758356
PDPs
301
MAPDs
IMBRUVICA 140 MG CAPSULE
(ibrutinib)
90 EA  5796201400959
PDPs
341
MAPDs
IMFINZI 120 MG/2.4 ML VIAL
(Durvalumab)
   0031045001245
PDPs
279
MAPDs
IMFINZI 500 MG/10 ML VIAL
(Durvalumab)
   0031046115045
PDPs
279
MAPDs
IMIPENEM-CILASTATIN 250 MG VL
(Imipenem-Cilastatin Intravenous For)
   0040935080159
PDPs
340
MAPDs
IMIPENEM-CILASTATIN 500 MG VL
(Imipenem-Cilastatin Intravenous For)
   0040935070159
PDPs
338
MAPDs
IMIPRAMINE HCL 10MG TABLET (100 CT)
(Imipramine HCl)
100 BOT4988400540159
PDPs
341
MAPDs
IMIPRAMINE HCL 25MG TABLET (100 CT)
(Imipramine HCl)
100 BOT4988400550159
PDPs
341
MAPDs
IMIPRAMINE HCL 50MG TABLET (100 CT)
(Imipramine HCl)
100 BOT5348903320159
PDPs
341
MAPDs
IMIPRAMINE PAMOATE 100MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402741323
PDPs
222
MAPDs
IMIPRAMINE PAMOATE 125MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402751323
PDPs
222
MAPDs
IMIPRAMINE PAMOATE 150MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402761323
PDPs
222
MAPDs
IMIPRAMINE PAMOATE 75MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402731323
PDPs
222
MAPDs
IMIQUIMOD 5% CREAM
(Imiquimod)
24 EA  0016804322459
PDPs
341
MAPDs
IMITREX 100MG TABLET
(Sumatriptan Succinate)
9 BLPK001730737015
PDPs
11
MAPDs
IMITREX 20MG NASAL SPRAY
(Sumatriptan Succinate)
6 X 1 UD NASAL SPRAY CTR001730523005
PDPs
29
MAPDs
IMITREX 25MG TABLET
(Sumatriptan Succinate)
1 BLPK001730735005
PDPs
11
MAPDs
IMITREX 4MG/0.5ML KIT REFILL
(Sumatriptan Succinate)
2 SYR001730739025
PDPs
20
MAPDs
IMITREX 5MG NASAL SPRAY
(Sumatriptan Succinate)
6 X 1 UNIT DOSE SPRAY CTR001730524005
PDPs
28
MAPDs
IMITREX 50MG TABLET
(Sumatriptan Succinate)
9 BLPK001730736015
PDPs
11
MAPDs
IMITREX 6MG/0.5ML SYRNG KIT
(Sumatriptan Succinate)
2 (STATDOSE) SYR001730478005
PDPs
13
MAPDs
IMITREX 6MG/0.5ML VIAL
(Sumatriptan Succinate)
5 X 0.5 ML VIAL001730449025
PDPs
13
MAPDs
IMOGAM RABIES-HT 150 UNIT/ML
(Rabies Immune Globulin (Human) USP)
   4928101905815
PDPs
154
MAPDs
IMOVAX RABIES VACCINE
(Rabies Virus Vaccine, HDC)
   4928102505159
PDPs
341
MAPDs
IMURAN 50MG TABLET
(Azathioprine)
100 BOT654830590108
PDPs
32
MAPDs
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE
(Mecasermin)
1 VIAL, MULTI-DOSE in 1 C  1505410400559
PDPs
340
MAPDs
INCRUSE ELLIPTA 62.5 MCG INH
(Umeclidinium)
   0017308731040
PDPs
230
MAPDs
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC
(Indapamide)
100 TABLET, FILM COATED i  0037800690157
PDPs
335
MAPDs
INDAPAMIDE 2.5MG TABLET USP (1000 CT)
(Indapamide)
1000 BOT0037800801057
PDPs
335
MAPDs
INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT
(Propranolol HCl)
100 BOT240900473884
PDPs
9
MAPDs
INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT
(Propranolol HCl)
100 BOT240900479884
PDPs
9
MAPDs
INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT
(Propranolol HCl)
100 BOT240900470884
PDPs
9
MAPDs
INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT
(Propranolol HCl)
100 BOT240900471884
PDPs
9
MAPDs
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT
(Indomethacin)
237 ML BOT422110101112
PDPs
41
MAPDs
Indomethacin 25 mg capsule
(Indomethacin)
   3172205421014
PDPs
180
MAPDs
INDOMETHACIN 50 MG CAPSULE
(Indomethacin)
100 EA  3172205430113
PDPs
180
MAPDs
INDOMETHACIN 75MG CAPSULE SA
(Indomethacin)
60 BOTPL0018507206010
PDPs
164
MAPDs
INFLECTRA 100 MG VIAL
(Infliximab-dyyb)
   000690809019
PDPs
130
MAPDs
INGREZZA 40 MG CAPSULE
(Valbenazine)
   703701040019
PDPs
89
MAPDs
INLYTA 1 MG TABLET
(axitinib)
   0006901450159
PDPs
341
MAPDs
INLYTA 5 MG TABLET
(axitinib)
   0006901511159
PDPs
341
MAPDs
INNOPRAN XL 120 MG CAPSULE
(Propranolol HCl Sustained-Release Beads)
30 EA  240900451855
PDPs
53
MAPDs
INNOPRAN XL 80 MG CAPSULE
(Propranolol HCl Sustained-Release Beads)
30 EA  240900450855
PDPs
53
MAPDs
INSPRA 25MG TABLET
(Eplerenone)
90 TABLETS BOT000251710024
PDPs
9
MAPDs
INSPRA 50 MG TABLET
(Eplerenone)
90 EA  000251720014
PDPs
9
MAPDs
INTELENCE 100MG TABLET
(Etravirine)
120 TABLETS BOT5967605700159
PDPs
341
MAPDs
Intelence 200mg/1
(Etravirine)
   5967605710159
PDPs
341
MAPDs
INTELENCE 25 MG TABLET
(Etravirine)
120 EA  5967605720159
PDPs
341
MAPDs
INTRALIPID 20% IV FAT EMUL
(Fat)
   0033805191457
PDPs
304
MAPDs
INTRALIPID 30% IV FAT EMUL
(Fat)
   0033805201347
PDPs
229
MAPDs
INTRON A 10 MILLION UNITS VIAL
(Interferon Alfa-2B)
   0008543500159
PDPs
338
MAPDs
INTRON A 18 MILLION UNITS VIAL
(Interferon Alfa-2B)
1 EA  0008543510159
PDPs
328
MAPDs
INTRON A 6MMU/ML VIAL
(Interferon Alfa-2B)
3 ML VIAL0008511680159
PDPs
341
MAPDs
INTRON A 25 MILLION UNIT/2.5ML
(Interferon Alfa-2B)
3.2 ML  0008511330159
PDPs
335
MAPDs
INTRON A 50 MILLION UNITS VIAL
(Interferon Alfa-2B)
1 EA  0008543520159
PDPs
328
MAPDs
Introvale 3 CARTON in 1 BOX / 1 KIT per CARTON
(INTROVALE)
3 CARTON in 1 BOX / 1 KIT  0078155843657
PDPs
306
MAPDs
INVANZ 1GM VIAL
(Ertapenem Sodium For)
10X 1 GM VIAL0000638437149
PDPs
331
MAPDs
INVEGA ER 1.5mg/ 30 TABLET BOTTLE
(Paliperidone Palmitate IM Extended-Release)
30 TABLET, EXTENDED RELEA  5045805540111
PDPs
63
MAPDs
INVEGA TRINZA 273 MG/0.875 ML
(Paliperidone Palmitate)
0.875 ML  5045806060159
PDPs
333
MAPDs
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR
(Paliperidone)
30 BOT5045805500111
PDPs
63
MAPDs
INVEGA TRINZA 410 MG/1.315 ML
(Paliperidone Palmitate)
1.315 ML  5045806070159
PDPs
333
MAPDs
INVEGA TRINZA 546 MG/1.75 ML
(Paliperidone Palmitate)
1.75 ML  5045806080159
PDPs
333
MAPDs
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR
(Paliperidone)
30 BOT5045805510111
PDPs
63
MAPDs
INVEGA TRINZA 819 MG/2.625 ML
(Paliperidone Palmitate)
2.625 ML  5045806090159
PDPs
333
MAPDs
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR
(Paliperidone)
30 BOT5045805520112
PDPs
63
MAPDs
Invega Sustenna 117 mg/0.75mL Prefilled Syringe
(Paliperidone Palmitate)
0.75 ML  5045805620159
PDPs
341
MAPDs
Invega Sustenna 156 mg/mL Prefilled Syringe
(Paliperidone Palmitate)
1 ML  5045805630159
PDPs
341
MAPDs
Invega Sustenna 234 mg/1.5mL Prefilled Syringe
(Paliperidone Palmitate)
1.5 ML  5045805640159
PDPs
341
MAPDs
Invega Sustenna 39 mg/0.25mL Prefilled Syringe
(Paliperidone Palmitate)
0.25 ML  5045805600159
PDPs
341
MAPDs
Invega Sustenna 78 mg/0.5mL Prefilled Syringe
(Paliperidone Palmitate)
0.5 ML  5045805610159
PDPs
341
MAPDs
INVIRASE 200MG CAPSULE
(Saquinavir Mesylate)
270 BOT0000402451559
PDPs
341
MAPDs
INVIRASE 500MG TABLET
(Saquinavir Mesylate)
120 BOT0000402445159
PDPs
341
MAPDs
INVOKAMET 150-1,000 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805436047
PDPs
280
MAPDs
INVOKAMET XR 150-1,000 MG TAB
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809430147
PDPs
275
MAPDs
INVOKAMET 150-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805426047
PDPs
280
MAPDs
INVOKAMET XR 150-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809420147
PDPs
275
MAPDs
INVOKAMET 50-1,000 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805416047
PDPs
280
MAPDs
INVOKAMET XR 50-1,000 MG TAB
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809410147
PDPs
275
MAPDs
INVOKAMET 50-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805406047
PDPs
280
MAPDs
INVOKAMET XR 50-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809400147
PDPs
275
MAPDs
INVOKANA 100 MG TABLET
(Canagliflozin)
30 EA  5045801403049
PDPs
292
MAPDs
INVOKANA 300 MG TABLET
(Canagliflozin)
30 EA  5045801413049
PDPs
292
MAPDs
IONOSOL B-D5W IV SOLUTION
(Electrolyte-B in D5W)
12 X 1000 ML BAG0040973710931
PDPs
213
MAPDs
IONOSOL MB-D5W IV SOLUTION
(Electrolyte-MB in D5W)
24 X 500 ML CTR0040973720331
PDPs
214
MAPDs
IOPIDINE 0.5% EYE DROPS
(Apraclonidine HCl Ophth)
10 ML BOTDR000650665103
PDPs
15
MAPDs
IOPIDINE 1% EYE DROPS
(Apraclonidine HCl Ophth)
0.1 ML CTR000650660108
PDPs
112
MAPDs
IPOL VIAL 40;8;32; UNT
(Poliovirus Vaccine, IPV)
10 DOSE VIAL4928108601059
PDPs
341
MAPDs
IPRATROPIUM BROMIDE NASAL SPRAY
(Ipratropium Bromide Nasal)
345 SPRAY CRTN 0005400454459
PDPs
341
MAPDs
Ipratropium Bromide 0.5mg/2.5mL 1 POUCH per CARTON / 30 VIAL in 1 POUCH / 2.5 mL in 1 VIAL
(Ipratropium Bromide)
1 POUCH in 1 CARTON / 30  0059137983059
PDPs
341
MAPDs
Ipratropium Bromide 42ug/1 1 BOTTLE, SPRAY per CARTON / 165 SPRAY, METERED in 1 BOTTLE, SPRAY
(Ipratropium Bromide)
1 BOTTLE, SPRAY in 1 CART  2420803991559
PDPs
341
MAPDs
IRBESARTAN 150 MG TABLET [Avapro]
(Irbesartan)
30.000 EA  4354702780359
PDPs
337
MAPDs
IRBESARTAN 300 MG TABLET [Avapro]
(Irbesartan)
90 EA  3172207319059
PDPs
337
MAPDs
IRBESARTAN 75 MG TABLET [Avapro]
(Irbesartan)
30 EA  0005402501359
PDPs
337
MAPDs
IRBESARTAN-HCTZ 150-12.5 MG TB [Avalide]
(Irbesartan-Hydrochlorothiazide)
30 EA  3334200570755
PDPs
334
MAPDs
Irbesartan-hctz 300-12.5 mg tb [Avalide]
(Irbesartan-Hydrochlorothiazide)
   0005402551355
PDPs
334
MAPDs
IRESSA 250 MG TABLET
(Gefitinib)
30 EA  0031004823059
PDPs
341
MAPDs
irinotecan hcl 100 mg/5 ml vl
(Irinotecan HCl)
 6332301930550
PDPs
298
MAPDs
ISENTRESS 100 MG TABLET CHEW
(Raltegravir Potassium)
   0000604776159
PDPs
341
MAPDs
ISENTRESS 100 MG POWDER PACKET
(Raltegravir Potassium)
   0000636036059
PDPs
341
MAPDs
ISENTRESS 25 MG TABLET CHEW
(Raltegravir Potassium)
   0000604736159
PDPs
341
MAPDs
ISENTRESS 400MG TABLET
(Raltegravir Potassium)
60 BOT0000602276159
PDPs
341
MAPDs
ISOLYTE P IN 5% DEXTROSE INJECTION
(Electrolyte-P in D5W)
24 X 500 ML BAG0026477301040
PDPs
245
MAPDs
ISOLYTE S IV SOLUTION-EXCEL
(Electrolyte-S)
1000 ML X 12 CASE0026477030040
PDPs
249
MAPDs
ISONIAZID INJ 100MG/ML
(Isoniazid)
10 ML VIALMD0078130567046
PDPs
280
MAPDs
ISONIAZID 100 MG TABLET
(Isoniazid)
100 EA  0055500660259
PDPs
341
MAPDs
ISONIAZID 300 MG TABLET
(Isoniazid)
1000 EA  0052711091059
PDPs
341
MAPDs
ISONIAZID 50MG/5ML SYRUP
(Isoniazid)
16 FLO BOT4628700090149
PDPs
304
MAPDs
ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980203156
PDPs
38
MAPDs
ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980204156
PDPs
38
MAPDs
ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980206156
PDPs
38
MAPDs
ISORDIL 40 MG TABLET
(Isosorbide Dinitrate)
   001870192019
PDPs
85
MAPDs
ISORDIL TITRADOSE 5 MG TAB
(Isosorbide Dinitrate)
   001870152015
PDPs
30
MAPDs
ISOSORBIDE DN 20MG TABLET
(Isosorbide Dinitrate)
100 BOT0014317720159
PDPs
341
MAPDs
ISOSORBIDE DN 30MG TABLET
(Isosorbide Dinitrate)
1000 BOT4988400091057
PDPs
336
MAPDs
ISOSORBIDE DINITRATE 40MG TABLETS EXTENDED RELEASE
(Isosorbide Dinitrate)
100 BOT 5766406008849
PDPs
315
MAPDs
ISOSORBIDE DN 10 MG TABLET
(Isosorbide Dinitrate)
1000 EA  0078115561059
PDPs
341
MAPDs
ISOSORBIDE DN 5 MG TABLET
(Isosorbide Dinitrate)
100 EA  0014317690159
PDPs
341
MAPDs
ISOSORBIDE MN 10 MG TABLET
(Isosorbide Mononitrate)
100 EA  0022826311157
PDPs
334
MAPDs
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT)
(Isosorbide Mononitrate)
100 TABLETS BOT6217501293759
PDPs
341
MAPDs
ISOSORBIDE MONONITRATE 20MG TABLET
(Isosorbide Mononitrate)
100 BOT0014313330157
PDPs
335
MAPDs
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT)
(Isosorbide Mononitrate)
100 BOT0014322300159
PDPs
341
MAPDs
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT
(Isosorbide Mononitrate)
100 TABLETS BOT6217501193759
PDPs
341
MAPDs
ISOTONIC GENTAMICIN 100 MG/100 ML
(Gentamicin in Saline)
100 ML  0033805054853
PDPs
295
MAPDs
ISOTON GENTAMICIN 80MG/100ML
(Gentamicin in Saline)
100 ML BAG0033805034853
PDPs
279
MAPDs
ISOTONIC GENTAMICIN 80 MG/50 ML
(Gentamicin in Saline)
50 ML  0033805094153
PDPs
289
MAPDs
ISRADIPINE CAPSULES 2.5MG (100 CT)
(Isradipine)
100 BOT1625205390140
PDPs
290
MAPDs
ISRADIPINE CAPSULES 5MG (100 CT)
(Isradipine)
100 BOT1625205400140
PDPs
290
MAPDs
ISTALOL 0.5% EYE DROPS
(Timolol Maleate Ophth)
   2420800040130
PDPs
135
MAPDs
ISTODAX 10 MG VIAL
(Romidepsin)
   5957209840150
PDPs
289
MAPDs
ITRACONAZOLE 100MG CAPSULE
(Itraconazole)
30 CAPS BOT0018505503059
PDPs
341
MAPDs
IVERMECTIN 3 MG TABLET [Stromectol, Sklice]
(Ivermectin)
20 EA  4279908060159
PDPs
327
MAPDs
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML
(Japanese Encephalitis Vaccine Inactivated Adsorbed)
0.5ML SYR4251500010159
PDPs
341
MAPDs
KALYDECO 150 MG TABLET
(ivacaftor)
56.000 EA  5116702000159
PDPs
341
MAPDs
KALYDECO 50 MG GRANULES PACKET
(ivacaftor)
56 EA  5116703000153
PDPs
330
MAPDs
KALYDECO 75 MG GRANULES PACKET
(ivacaftor)
56 EA  5116704000153
PDPs
330
MAPDs
LANTUS 100U/ML VIAL
(Insulin Glargine)
10 ML VIAL0008822203356
PDPs
337
MAPDs
LANTUS SOLOSTAR INJECTION
(Insulin Glargine)
3 ML X 5 CRTG CRTN 0008822190556
PDPs
334
MAPDs
LEVEMIR 100UNITS/ML VIAL
(Insulin Detemir)
1 X 10 ML VIAL0016936871244
PDPs
281
MAPDs
LEVEMIR FLEXTOUCH 100 UNITS/ML
(Insulin Detemir)
3 ML 0016964381044
PDPs
280
MAPDs
MARPLAN 10MG TABLET (100 CT)
(Isocarboxazid)
100 BOT3069800320159
PDPs
341
MAPDs
MYORISAN 10 MG CAPSULE
(Isotretinoin)
30.000 EA  6174803011345
PDPs
252
MAPDs
MYORISAN 20 MG CAPSULE
(Isotretinoin)
100 EA  6174803021145
PDPs
251
MAPDs
Myorisan 30 mg capsule
(Isotretinoin)
   6174803031342
PDPs
248
MAPDs
MYORISAN 40 MG CAPSULE
(Isotretinoin)
100 EA  6174803041145
PDPs
251
MAPDs
NINLARO 2.3 MG CAPSULE
(Ixazomib)
   6302000780159
PDPs
341
MAPDs
NINLARO 3 MG CAPSULE
(Ixazomib)
   6302000790159
PDPs
341
MAPDs
NINLARO 4 MG CAPSULE
(Ixazomib)
   6302000800159
PDPs
341
MAPDs
Novolin 100[USP'U]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL
(Insulin Isophane & Regular (Human))
1 VIAL in 1 CARTON / 10 m  0016918371127
PDPs
239
MAPDs
Novolin 100[iU]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL
(Insulin Isophane (Human))
1 VIAL in 1 CARTON / 10 m  0016918341127
PDPs
239
MAPDs
Novolin R 100[iU]/mL 1 VIAL per CARTON / 10 mL in 1 VIAL
(Insulin Regular (Human))
1 VIAL in 1 CARTON / 10 m  0016918331127
PDPs
245
MAPDs
NOVOLOG 100U/ML VIAL
(Insulin Aspart)
1 X 10ML VIALGL0016975011128
PDPs
252
MAPDs
NOVOLOG 100 UNIT/ML CARTRIDGE
(Insulin Aspart)
3 ML  0016933031228
PDPs
251
MAPDs
NOVOLOG FLEXPEN SYRINGE
(Insulin Aspart)
5 X 3ML SYR0016963391028
PDPs
251
MAPDs
NOVOLOG MIX 70/30 VIAL
(Insulin Aspart Prot & Aspart (Human))
1 VIAL0016936851228
PDPs
252
MAPDs
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML
(Insulin Aspart Prot & Aspart (Human))
5 X 3 ML SYR0016936961928
PDPs
251
MAPDs
OCTAGAM 10% VIAL
(Immune Globulin (Human) IV)
   6898208500135
PDPs
206
MAPDs
OCTAGAM 5% VIAL
(Immune Globulin (Human) IV)
   6898208400135
PDPs
204
MAPDs
ONMEL 200 MG TABLET
(itraconazole)
   0025914202810
PDPs
59
MAPDs
PALIPERIDONE ER 1.5 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839789357
PDPs
341
MAPDs
PALIPERIDONE ER 3 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839799357
PDPs
341
MAPDs
PALIPERIDONE ER 6 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839809357
PDPs
341
MAPDs
PALIPERIDONE ER 9 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839819357
PDPs
341
MAPDs
PHYSIOLYTE SOLUTION FOR IRRIGATION
(Irrigation Solution, Physiological)
1000 ML X 16 CASE0026422050021
PDPs
129
MAPDs
PHYSIOSOL IRRIGATION SOL
(Irrigation Solution, Physiological)
24 X 500 ML CTR0040961410321
PDPs
131
MAPDs
PICATO 0.015% GEL
(ingenol mebutate)
   5022205024747
PDPs
260
MAPDs
PICATO 0.05% GEL
(ingenol mebutate)
   5022205034747
PDPs
260
MAPDs
PRIMAXIN IV 250MG VIAL
(Imipenem-Cilastatin Intravenous For)
25 X 10 ML VIAL000063514581
PDPs
13
MAPDs
PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS
(Imipenem-Cilastatin Intravenous For)
25 VIAL, SINGLE-DOSE in 1  000063516591
PDPs
14
MAPDs
PRIVIGEN 10% VIAL
(Immune Globulin (Human) IV)
200 ML  4420604382042
PDPs
258
MAPDs
REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS
(Interferon Beta-1a)
12 SYRINGE, GLASS in 1 CA  4408700220322
PDPs
209
MAPDs
REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS
(Interferon Beta-1a)
12 SYRINGE, GLASS in 1 CA  4408700440322
PDPs
206
MAPDs
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL
(Interferon Beta-1a)
   4408788220122
PDPs
206
MAPDs
REBIF REBIDOSE TITRATION PACK
(Interferon Beta-1a)
4.2 ML  4408701880122
PDPs
196
MAPDs
REBIF REBIDOSE 22 MCG/0.5 ML
(Interferon Beta-1a)
0.5 ML  4408733220122
PDPs
196
MAPDs
REBIF REBIDOSE 44 MCG/0.5 ML
(Interferon Beta-1a)
0.5 ML  4408733440122
PDPs
197
MAPDs
Regular Insulin, Human 12 UNT Inhalant Powder [Afrezza]
(insulin)
   479180891905
PDPs
40
MAPDs
Regular Insulin, Human 8 UNT Inhalant Powder [Afrezza]
(insulin)
   479180878905
PDPs
40
MAPDs
REMICADE 100MG VIAL
(Infliximab For IV)
20 ML VIALSU5789400300158
PDPs
319
MAPDs
RIFAMATE 150/300 CAPSULE
(Isoniazid & Rifampin)
60 BOT000680509605
PDPs
80
MAPDs
RIFATER 50/300/120 TABLET
(Isoniazid-Rifampin w/ Pyrazinamide)
60 BOT0008805764145
PDPs
295
MAPDs
SKLICE 0.5% LOTION
(ivermectin)
117.000 GM  243380183046
PDPs
62
MAPDs
SOLIQUA 100 UNIT-33 MCG/ML PEN
(Insulin glargine and lixisenatide)
   000245761057
PDPs
26
MAPDs
SOOLANTRA 1% CREAM
(Ivermectin)
   0029938233012
PDPs
57
MAPDs
SPORANOX 10MG/ML SOLUTION
(Itraconazole)
150 ML BOT5045802951522
PDPs
131
MAPDs
SPORANOX 100MG CAPSULE
(Itraconazole)
30 BOT504580290044
PDPs
11
MAPDs
STROMECTOL 3MG TABLET
(Ivermectin)
20 X 1 TABLET BOXUD0000600322011
PDPs
25
MAPDs
TALTZ 80 MG/ML AUTOINJ (3-PK)
(Ixekizumab)
   000021445096
PDPs
78
MAPDs
TALTZ 80 MG/ML SYRINGE
(Ixekizumab)
   000027724016
PDPs
77
MAPDs
TIVORBEX 20 MG CAPSULE
(Indomethacin)
   422110201292
PDPs
7
MAPDs
TIVORBEX 40 MG CAPSULE
(Indomethacin)
   422110202292
PDPs
7
MAPDs
TOFRANIL TABLETS 10MG 30 BOT
(Imipramine HCl)
30 BOT004069920031
PDPs
10
MAPDs
TOFRANIL TABLETS 25MG 30 BOT
(Imipramine HCl)
30 BOT004069921031
PDPs
10
MAPDs
TOFRANIL 50MG TABLET (30 CT)
(Imipramine HCl)
30 BOT004069922031
PDPs
10
MAPDs
TOUJEO SOLOSTAR 300 UNITS/ML
(Insulin Glargine)
1.5 ML  0002458690354
PDPs
288
MAPDs
TRESIBA FLEXTOUCH 100 UNITS/ML
(Insulin Degludec)
   0016926601526
PDPs
162
MAPDs
TRESIBA FLEXTOUCH 200 UNITS/ML
(Insulin Degludec)
   0016925501326
PDPs
162
MAPDs
Ventavis 0.01mg/mL
(Iloprost)
   6621503023051
PDPs
267
MAPDs
Ventavis 0.02mg/mL
(Iloprost)
   6621503033049
PDPs
264
MAPDs
YERVOY 5mg/mL 1 VIAL, SINGLE-USE per CARTON / 50 mL in 1 VIAL, SINGLE-USE
(IPILIMUMAB)
1 VIAL, SINGLE-USE in 1 C  0000323271159
PDPs
339
MAPDs
ZENATANE 10 MG CAPSULE
(Isotretinoin)
30 EA  5511101358141
PDPs
270
MAPDs
ZENATANE 20 MG CAPSULE
(Isotretinoin)
   5511101367941
PDPs
271
MAPDs
ZENATANE 30 MG CAPSULE
(Isotretinoin)
30 EA  5511101138142
PDPs
276
MAPDs
ZENATANE 40 MG CAPSULE
(Isotretinoin)
   5511101377941
PDPs
271
MAPDs
ZYCLARA 2.5% CREAM PUMP
(Imiquimod)
   992070276759
PDPs
120
MAPDs
ZYCLARA 3.75% CREAM
(Imiquimod)
28 EA  992070270289
PDPs
111
MAPDs
ZYDELIG 100 MG TABLET
(Idelalisib)
60 EA  6195817010159
PDPs
341
MAPDs
ZYDELIG 150 MG TABLET
(Idelalisib)
60 EA  6195817020159
PDPs
341
MAPDs



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


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  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • 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.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • 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.