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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
22
MAPDs
ABSORICA 20 MG CAPSULE
(Isotretinoin)
   106310116312
PDPs
22
MAPDs
ABSORICA 25 MG CAPSULE
(Isotretinoin)
   106310133312
PDPs
27
MAPDs
ABSORICA 30 MG CAPSULE
(Isotretinoin)
   106310117312
PDPs
22
MAPDs
ABSORICA 35 MG CAPSULE
(Isotretinoin)
   106310134312
PDPs
27
MAPDs
ABSORICA 40 MG CAPSULE
(Isotretinoin)
   106310118312
PDPs
22
MAPDs
ACTIMMUNE 100 MCG/0.5 ML VIAL
(Interferon Gamma-1B)
.5 ML  4223801110157
PDPs
334
MAPDs
AFREZZA 30-4 UNIT + 60-8 UNIT
(insulin)
   479180882364
PDPs
46
MAPDs
AFREZZA 4 UNITS CARTRIDGE INH
(insulin)
   479180874904
PDPs
46
MAPDs
AFREZZA 4 UNIT/8 UNIT/12 UNIT
(insulin)
   479180902184
PDPs
46
MAPDs
AFREZZA 60-4 UNIT + 30-8 UNIT
(insulin)
   479180884634
PDPs
46
MAPDs
AFREZZA 60-8 UNIT + 30-12 UNIT
(insulin)
   479180894634
PDPs
46
MAPDs
AFREZZA 90-4 UNIT / 90-8 UNIT
(insulin)
   479180880184
PDPs
46
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  0009367237345
PDPs
268
MAPDs
ALDARA 5% CREAM
(Imiquimod)
   992070260125
PDPs
11
MAPDs
APIDRA 100 UNITS/ML VIAL
(Insulin Glulisine Subcutaneous)
10 ML  000882500335
PDPs
77
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
105
MAPDs
ATROVENT HFA AER 17MCG
(Ipratropium Bromide HFA)
12.9 GRAMS PER 200 ACT CAN0059700871753
PDPs
320
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  5962702220533
PDPs
251
MAPDs
AVONEX ADMIN PACK 30 MCG VL
(INTERFERON BETA-1A/ALBUMIN)
4 EA  5962701110333
PDPs
257
MAPDs
AVONEX PEN 30 MCG/0.5 ML KIT
(INTERFERON BETA-1A)
1 EA  5962703330433
PDPs
251
MAPDs
BASAGLAR 100 UNIT/ML KWIKPEN
(Insulin glargine)
   000027715012
PDPs
25
MAPDs
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM
(Interferon Beta-1b For)
14 TRAY BOX PKGCOM5041905233547
PDPs
290
MAPDs
BIDIL TABLET
(Isosorbide Dinitrate-Hydralazine HCl)
180 EA  2433800101822
PDPs
138
MAPDs
BIVIGAM LIQUID 10% VIAL
(immune globulin intravenous)
   5973065030134
PDPs
193
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
246
MAPDs
CEREZYME 400 UNITS VIAL
(Imiglucerase For)
   5846846630157
PDPs
330
MAPDs
CLARAVIS 10 MG CAPSULE
(Isotretinoin)
100 BLPK0055510545650
PDPs
280
MAPDs
CLARAVIS 20 MG CAPSULE
(Isotretinoin)
100 BLPK0055510555652
PDPs
280
MAPDs
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK
(Isotretinoin)
3 BLISTER PACK in 1 CARTO  0055510568652
PDPs
278
MAPDs
CLARAVIS 40MG CAPSULE
(Isotretinoin)
100 BLPK0055510575652
PDPs
280
MAPDs
CORLANOR 5 MG TABLET
(IVABRADINE HYDROCHLORIDE)
60 EA  5551308006025
PDPs
187
MAPDs
CORLANOR 7.5 MG TABLET
(IVABRADINE HYDROCHLORIDE)
60 EA  5551308106025
PDPs
187
MAPDs
CRESEMBA 186 MG CAPSULE
(Isavuconazonium Sulfate)
   0046905201425
PDPs
131
MAPDs
CRESEMBA 372 MG VIAL
(Isavuconazonium Sulfate)
   0046904209925
PDPs
131
MAPDs
CRIXIVAN 200MG CAPSULE
(Indinavir Sulfate)
360 BOT0000605714357
PDPs
334
MAPDs
CRIXIVAN 400mg, 180 CAPSULE BOTTLE
(Indinavir Sulfate)
180 CAPSULE in 1 BOTTLE  0000605736257
PDPs
334
MAPDs
DUEXIS 26.6; 800mg/1; mg/1
(IBUPROFEN AND FAMOTIDINE)
   759870010033
PDPs
24
MAPDs
ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS
(Idursulfase)
1 VIAL, GLASS in 1 BOX /  5409207000134
PDPs
241
MAPDs
EXTAVIA 15 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK
(Interferon Beta-1b For)
15 BLISTER PACK in 1 CART  0007805691218
PDPs
148
MAPDs
FANAPT 4 MG TABLET
(ILOPERIDONE)
60 EA  4306801040255
PDPs
334
MAPDs
FANAPT TITR TABLETS
(ILOPERIDONE)
8 EA  4306801130457
PDPs
329
MAPDs
FANAPT 1 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801010257
PDPs
334
MAPDs
FANAPT 10 MG TABLET
(ILOPERIDONE)
60 EA  4306801100257
PDPs
334
MAPDs
FANAPT 12 MG TABLET
(ILOPERIDONE)
   4306801120257
PDPs
334
MAPDs
FANAPT 2 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801020257
PDPs
334
MAPDs
FANAPT 6 MG TABLET
(ILOPERIDONE)
60.000 EA  4306801060257
PDPs
334
MAPDs
FANAPT 8 MG TABLET
(ILOPERIDONE)
60 EA  4306801080257
PDPs
334
MAPDs
Firazyr 30.0mg/3mL 1 SYRINGE, GLASS per CARTON / 3 mL in 1 SYRINGE, GLASS
(ICATIBANT ACETATE)
1 SYRINGE, GLASS in 1 CAR  5409207020257
PDPs
334
MAPDs
FLEBOGAMMA DIF INJECTION
(Immune Globulin (Human) IV)
   6195300050129
PDPs
218
MAPDs
GamaSTAN S/D 0.165g/mL
(Immune Globulin (Human))
   1353306351242
PDPs
260
MAPDs
GAMASTAN S-D 10 ML
(Immune Globulin (Human))
   1353306351336
PDPs
239
MAPDs
GAMASTAN S-D 2 ML
(Immune Globulin (Human))
   1353306354036
PDPs
239
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
269
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  7612509000128
PDPs
190
MAPDs
GAMMAPLEX INJECTION 5 GM/100 ML
(Immune Globulin)
   6420882340344
PDPs
252
MAPDs
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS
(Immune Globulin (Human) IV)
10 mL in 1 VIAL, GLASS  1353308001242
PDPs
285
MAPDs
GLEEVEC 100MG TABLET (90 CT)
(Imatinib Mesylate)
90 BOT0007804013412
PDPs
117
MAPDs
GLEEVEC 400 MG TABLET
(Imatinib Mesylate)
30 EA  0007806493012
PDPs
117
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  0000275101736
PDPs
201
MAPDs
HUMALOG 100 UNITS/ML CARTRIDGE
(Insulin Lispro (Human))
3 ML  0000275165936
PDPs
193
MAPDs
HUMALOG KWIKPEN INJECTION
(Insulin Lispro (Human))
3 ML X 5 SYR CRTN 0000287995936
PDPs
197
MAPDs
HUMALOG MIX 50/50 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10 ML VIAL0000275120136
PDPs
202
MAPDs
HUMALOG MIX 75/25 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10ML VIAL0000275110136
PDPs
202
MAPDs
HUMALOG MIX KWIKPEN INJECTION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 0000287985936
PDPs
199
MAPDs
HUMALOG MIX KWIKPEN INJECTION SUSPENSION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 0000287975936
PDPs
199
MAPDs
HUMALOG 200 UNITS/ML KWIKPEN
(Insulin Lispro (Human))
   0000277122736
PDPs
195
MAPDs
HUMULIN 70/30 VIAL
(Insulin Isophane & Regular (Human))
1 X 10 ML VIAL0000287150136
PDPs
198
MAPDs
HUMULIN 70-30 PEN
(Insulin Isophane & Regular (Human))
   0000288030134
PDPs
196
MAPDs
HUMULIN N 100 UNITS/ML PEN
(Insulin Isophane (Human))
   0000288050134
PDPs
196
MAPDs
HUMULIN N 100U/ML VIAL
(Insulin Isophane (Human))
10 ML VIAL0000283150136
PDPs
199
MAPDs
HUMULIN R 100U/ML VIAL
(Insulin Regular (Human))
1 X 10 ML VIAL0000282150136
PDPs
205
MAPDs
HUMULIN R 500 UNITS/ML KWIKPEN
(Insulin Regular (Human))
   0000288242749
PDPs
269
MAPDs
HUMULIN R 500U/ML VIAL
(Insulin Regular (Human))
1 X 20 ML VIAL0000285010153
PDPs
290
MAPDs
IBANDRONATE SODIUM 150 MG TABLET [Boniva]
(Ibandronate Sodium)
   6050527950045
PDPs
274
MAPDs
IBANDRONATE 3 MG/3 ML VIAL [Boniva]
(Ibandronate Sodium)
   6275602184030
PDPs
232
MAPDs
IBRANCE 100 MG CAPSULE
(Palbociclib)
21 EA  0006901882157
PDPs
334
MAPDs
IBRANCE 125 MG CAPSULE
(Palbociclib)
21 EA  0006901892157
PDPs
334
MAPDs
IBRANCE 75 MG CAPSULE
(Palbociclib)
21 EA  0006901872157
PDPs
334
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  4580209524355
PDPs
316
MAPDs
IBUPROFEN 400MG TABLETS
(Ibuprofen)
100 BOXUD 0090458536157
PDPs
334
MAPDs
IBUPROFEN 600mg/1 500 TABLET BOTTLE
(Ibuprofen)
500 TABLET BOTTLE  5374604650557
PDPs
334
MAPDs
Ibuprofen 800mg/1 100 TABLET BOTTLE
(Ibuprofen)
100 TABLET in 1 BOTTLE  5374604660157
PDPs
334
MAPDs
ICLUSIG 15 MG TABLET
(ponatinib)
30 EA  7618905353057
PDPs
334
MAPDs
ICLUSIG 45 MG TABLET
(ponatinib)
30 EA  7618905343057
PDPs
334
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 PKG0070341551148
PDPs
269
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 VIALSD6332301421049
PDPs
298
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  0007805826138
PDPs
249
MAPDs
ILEVRO 0.3% OPHTH DROPS
(nepafenac Dosage)
1.7 ML  0006517500750
PDPs
258
MAPDs
IMATINIB MESYLATE 100 MG TABLET [Gleevec]
(Imatinib Mesylate)
90 EA  4733504728154
PDPs
294
MAPDs
IMATINIB MESYLATE 400 MG TABLET [Gleevec]
(Imatinib Mesylate)
30 EA  4733504758354
PDPs
294
MAPDs
IMBRUVICA 140 MG CAPSULE
(ibrutinib)
90 EA  5796201400957
PDPs
334
MAPDs
IMIPENEM-CILASTATIN 250 MG VL
(Imipenem-Cilastatin Intravenous For)
   0040935080157
PDPs
333
MAPDs
IMIPENEM-CILASTATIN 500 MG VL
(Imipenem-Cilastatin Intravenous For)
   0040935070157
PDPs
331
MAPDs
IMIPRAMINE HCL 10MG TABLET (100 CT)
(Imipramine HCl)
100 BOT4988400540157
PDPs
334
MAPDs
IMIPRAMINE HCL 25MG TABLET (100 CT)
(Imipramine HCl)
100 BOT4988400550157
PDPs
334
MAPDs
IMIPRAMINE HCL 50MG TABLET (100 CT)
(Imipramine HCl)
100 BOT5348903320157
PDPs
334
MAPDs
IMIPRAMINE PAMOATE 100MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402741321
PDPs
215
MAPDs
IMIPRAMINE PAMOATE 125MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402751321
PDPs
215
MAPDs
IMIPRAMINE PAMOATE 150MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402761321
PDPs
215
MAPDs
IMIPRAMINE PAMOATE 75MG CAPSULES
(Imipramine Pamoate)
30 BOT 0005402731321
PDPs
215
MAPDs
IMIQUIMOD 5% CREAM
(Imiquimod)
24 EA  0016804322457
PDPs
334
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)
   4928102505157
PDPs
334
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  1505410400557
PDPs
334
MAPDs
INCRUSE ELLIPTA 62.5 MCG INH
(Umeclidinium)
   0017308731038
PDPs
222
MAPDs
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC
(Indapamide)
100 TABLET, FILM COATED i  0037800690155
PDPs
328
MAPDs
INDAPAMIDE 2.5MG TABLET USP (1000 CT)
(Indapamide)
1000 BOT0037800801055
PDPs
328
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
40
MAPDs
INDOMETHACIN 25MG CAPSULES
(Indomethacin)
1000 BOT 0009340291014
PDPs
179
MAPDs
INDOMETHACIN 50 MG CAPSULE
(Indomethacin)
100 EA  3172205430113
PDPs
179
MAPDs
INDOMETHACIN 75MG CAPSULE SA
(Indomethacin)
60 BOTPL0018507206010
PDPs
163
MAPDs
INFLECTRA 100 MG VIAL
(Infliximab-dyyb)
   000690809019
PDPs
130
MAPDs
INLYTA 1 MG TABLET
(axitinib)
   0006901450157
PDPs
334
MAPDs
INLYTA 5 MG TABLET
(axitinib)
   0006901511157
PDPs
334
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 BOT5967605700157
PDPs
334
MAPDs
Intelence 200mg/1
(Etravirine)
   5967605710157
PDPs
334
MAPDs
INTELENCE 25 MG TABLET
(Etravirine)
120 EA  5967605720157
PDPs
334
MAPDs
INTRALIPID 20% IV FAT EMUL
(Fat)
   0033805191455
PDPs
297
MAPDs
INTRALIPID 30% IV FAT EMUL
(Fat)
   0033805201345
PDPs
222
MAPDs
INTRON A 10 MILLION UNITS VIAL
(Interferon Alfa-2B)
   0008543500157
PDPs
331
MAPDs
INTRON A 18 MILLION UNITS VIAL
(Interferon Alfa-2B)
1 EA  0008543510157
PDPs
321
MAPDs
INTRON A 6MMU/ML VIAL
(Interferon Alfa-2B)
3 ML VIAL0008511680157
PDPs
334
MAPDs
INTRON A 50 MILLION UNITS VIAL
(Interferon Alfa-2B)
1 EA  0008543520157
PDPs
321
MAPDs
Introvale 3 CARTON in 1 BOX / 1 KIT per CARTON
(INTROVALE)
3 CARTON in 1 BOX / 1 KIT  0078155843655
PDPs
299
MAPDs
INVANZ 1GM VIAL
(Ertapenem Sodium For)
10X 1 GM VIAL0000638437147
PDPs
324
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  5045806060157
PDPs
324
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  5045806070157
PDPs
324
MAPDs
INVEGA TRINZA 546 MG/1.75 ML
(Paliperidone Palmitate)
1.75 ML  5045806080157
PDPs
324
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  5045806090157
PDPs
324
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  5045805620157
PDPs
334
MAPDs
Invega Sustenna 156 mg/mL Prefilled Syringe
(Paliperidone Palmitate)
1 ML  5045805630157
PDPs
334
MAPDs
Invega Sustenna 234 mg/1.5mL Prefilled Syringe
(Paliperidone Palmitate)
1.5 ML  5045805640157
PDPs
334
MAPDs
Invega Sustenna 39 mg/0.25mL Prefilled Syringe
(Paliperidone Palmitate)
0.25 ML  5045805600157
PDPs
334
MAPDs
Invega Sustenna 78 mg/0.5mL Prefilled Syringe
(Paliperidone Palmitate)
0.5 ML  5045805610157
PDPs
334
MAPDs
INVIRASE 200MG CAPSULE
(Saquinavir Mesylate)
270 BOT0000402451557
PDPs
334
MAPDs
INVIRASE 500MG TABLET
(Saquinavir Mesylate)
120 BOT0000402445157
PDPs
334
MAPDs
INVOKAMET 150-1,000 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805436045
PDPs
271
MAPDs
INVOKAMET XR 150-1,000 MG TAB
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809430145
PDPs
264
MAPDs
INVOKAMET 150-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805426045
PDPs
271
MAPDs
INVOKAMET XR 150-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809420145
PDPs
264
MAPDs
INVOKAMET 50-1,000 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805416045
PDPs
271
MAPDs
INVOKAMET XR 50-1,000 MG TAB
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809410145
PDPs
264
MAPDs
INVOKAMET 50-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60 EA  5045805406045
PDPs
271
MAPDs
INVOKAMET XR 50-500 MG TABLET
(Canagliflozin and Metformin Hydrochloride)
60.000 EA  5045809400145
PDPs
264
MAPDs
INVOKANA 100 MG TABLET
(Canagliflozin)
30 EA  5045801403047
PDPs
283
MAPDs
INVOKANA 300 MG TABLET
(Canagliflozin)
30 EA  5045801413047
PDPs
283
MAPDs
IONOSOL B-D5W IV SOLUTION
(Electrolyte-B in D5W)
12 X 1000 ML BAG0040973710931
PDPs
211
MAPDs
IONOSOL MB-D5W IV SOLUTION
(Electrolyte-MB in D5W)
24 X 500 ML CTR0040973720331
PDPs
212
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
110
MAPDs
IPOL VIAL 40;8;32; UNT
(Poliovirus Vaccine, IPV)
10 DOSE VIAL4928108601057
PDPs
334
MAPDs
IPRATROPIUM BROMIDE NASAL SPRAY
(Ipratropium Bromide Nasal)
345 SPRAY CRTN 0005400454457
PDPs
334
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  0059137983057
PDPs
334
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  2420803991557
PDPs
334
MAPDs
IRBESARTAN 150 MG TABLET [Avapro]
(Irbesartan)
30.000 EA  4354702780357
PDPs
330
MAPDs
IRBESARTAN 300 MG TABLET [Avapro]
(Irbesartan)
90 EA  3172207319057
PDPs
330
MAPDs
IRBESARTAN 75 MG TABLET [Avapro]
(Irbesartan)
30 EA  0005402501357
PDPs
330
MAPDs
IRBESARTAN-HCTZ 150-12.5 MG TB [Avalide]
(Irbesartan-Hydrochlorothiazide)
30 EA  3334200570753
PDPs
327
MAPDs
Irbesartan-hctz 300-12.5 mg tb [Avalide]
(Irbesartan-Hydrochlorothiazide)
   0005402551353
PDPs
327
MAPDs
IRESSA 250 MG TABLET
(Gefitinib)
30 EA  0031004823057
PDPs
334
MAPDs
irinotecan hcl 100 mg/5 ml vl
(Irinotecan HCl)
 6332301930548
PDPs
291
MAPDs
ISENTRESS 100 MG TABLET CHEW
(Raltegravir Potassium)
   0000604776157
PDPs
334
MAPDs
ISENTRESS 100 MG POWDER PACKET
(Raltegravir Potassium)
   0000636036057
PDPs
334
MAPDs
ISENTRESS 25 MG TABLET CHEW
(Raltegravir Potassium)
   0000604736157
PDPs
334
MAPDs
ISENTRESS 400MG TABLET
(Raltegravir Potassium)
60 BOT0000602276157
PDPs
334
MAPDs
ISOLYTE P IN 5% DEXTROSE INJECTION
(Electrolyte-P in D5W)
24 X 500 ML BAG0026477301040
PDPs
243
MAPDs
ISOLYTE S IV SOLUTION-EXCEL
(Electrolyte-S)
1000 ML X 12 CASE0026477030040
PDPs
247
MAPDs
ISONIAZID INJ 100MG/ML
(Isoniazid)
10 ML VIALMD0078130567044
PDPs
273
MAPDs
ISONIAZID 100 MG TABLET
(Isoniazid)
100 EA  0055500660257
PDPs
334
MAPDs
ISONIAZID 300 MG TABLET
(Isoniazid)
1000 EA  0052711091057
PDPs
334
MAPDs
ISONIAZID 50MG/5ML SYRUP
(Isoniazid)
16 FLO BOT4628700090147
PDPs
297
MAPDs
ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980203156
PDPs
37
MAPDs
ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980204156
PDPs
37
MAPDs
ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE
(PILOCARPINE HYDROCHLORIDE)
15 mL in 1 BOTTLE  009980206156
PDPs
37
MAPDs
ISORDIL 40 MG TABLET
(Isosorbide Dinitrate)
   001870192019
PDPs
84
MAPDs
ISORDIL TITRADOSE 5 MG TAB
(Isosorbide Dinitrate)
   001870152015
PDPs
30
MAPDs
ISOSORBIDE DN 20MG TABLET
(Isosorbide Dinitrate)
100 BOT0014317720157
PDPs
334
MAPDs
ISOSORBIDE DN 30MG TABLET
(Isosorbide Dinitrate)
1000 BOT4988400091055
PDPs
329
MAPDs
ISOSORBIDE DINITRATE 40MG TABLETS EXTENDED RELEASE
(Isosorbide Dinitrate)
100 BOT 5766406008847
PDPs
308
MAPDs
ISOSORBIDE DN 10 MG TABLET
(Isosorbide Dinitrate)
1000 EA  0078115561057
PDPs
334
MAPDs
ISOSORBIDE DN 5 MG TABLET
(Isosorbide Dinitrate)
100 EA  0014317690157
PDPs
334
MAPDs
ISOSORBIDE MN 10 MG TABLET
(Isosorbide Mononitrate)
100 EA  0022826311155
PDPs
327
MAPDs
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT)
(Isosorbide Mononitrate)
100 TABLETS BOT6217501293757
PDPs
334
MAPDs
ISOSORBIDE MONONITRATE 20MG TABLET
(Isosorbide Mononitrate)
100 BOT0014313330155
PDPs
328
MAPDs
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT)
(Isosorbide Mononitrate)
100 BOT0014322300157
PDPs
334
MAPDs
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT
(Isosorbide Mononitrate)
100 TABLETS BOT6217501193757
PDPs
334
MAPDs
ISOTONIC GENTAMICIN 100 MG/100 ML
(Gentamicin in Saline)
100 ML  0033805054851
PDPs
288
MAPDs
ISOTON GENTAMICIN 80MG/100ML
(Gentamicin in Saline)
100 ML BAG0033805034851
PDPs
272
MAPDs
ISOTONIC GENTAMICIN 80 MG/50 ML
(Gentamicin in Saline)
50 ML  0033805094151
PDPs
282
MAPDs
ISRADIPINE CAPSULES 2.5MG (100 CT)
(Isradipine)
100 BOT1625205390138
PDPs
283
MAPDs
ISRADIPINE CAPSULES 5MG (100 CT)
(Isradipine)
100 BOT1625205400138
PDPs
283
MAPDs
ISTALOL 0.5% EYE DROPS
(Timolol Maleate Ophth)
   2420800040130
PDPs
135
MAPDs
ISTODAX 10 MG VIAL
(Romidepsin)
   5957209840148
PDPs
274
MAPDs
ITRACONAZOLE 100MG CAPSULE
(Itraconazole)
30 CAPS BOT0018505503057
PDPs
334
MAPDs
IVERMECTIN 3 MG TABLET [Stromectol, Sklice]
(Ivermectin)
20 EA  4279908060157
PDPs
320
MAPDs
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML
(Japanese Encephalitis Vaccine Inactivated Adsorbed)
0.5ML SYR4251500010157
PDPs
334
MAPDs
KALYDECO 150 MG TABLET
(ivacaftor)
56.000 EA  5116702000157
PDPs
334
MAPDs
KALYDECO 50 MG GRANULES PACKET
(ivacaftor)
56 EA  5116703000151
PDPs
323
MAPDs
KALYDECO 75 MG GRANULES PACKET
(ivacaftor)
56 EA  5116704000151
PDPs
323
MAPDs
LANTUS 100U/ML VIAL
(Insulin Glargine)
10 ML VIAL0008822203354
PDPs
330
MAPDs
LANTUS SOLOSTAR INJECTION
(Insulin Glargine)
3 ML X 5 CRTG CRTN 0008822190554
PDPs
327
MAPDs
LEVEMIR 100UNITS/ML VIAL
(Insulin Detemir)
1 X 10 ML VIAL0016936871242
PDPs
274
MAPDs
LEVEMIR FLEXTOUCH 100 UNITS/ML
(Insulin Detemir)
3 ML 0016964381042
PDPs
273
MAPDs
MARPLAN 10MG TABLET (100 CT)
(Isocarboxazid)
100 BOT3069800320157
PDPs
334
MAPDs
MYORISAN 10 MG CAPSULE
(Isotretinoin)
30.000 EA  6174803011342
PDPs
244
MAPDs
MYORISAN 20 MG CAPSULE
(Isotretinoin)
100 EA  6174803021142
PDPs
243
MAPDs
Myorisan 30 mg capsule
(Isotretinoin)
   6174803031339
PDPs
240
MAPDs
MYORISAN 40 MG CAPSULE
(Isotretinoin)
100 EA  6174803041142
PDPs
243
MAPDs
NINLARO 2.3 MG CAPSULE
(Ixazomib)
   6302000780157
PDPs
334
MAPDs
NINLARO 3 MG CAPSULE
(Ixazomib)
   6302000790157
PDPs
334
MAPDs
NINLARO 4 MG CAPSULE
(Ixazomib)
   6302000800157
PDPs
334
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
238
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
238
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
244
MAPDs
NOVOLOG 100U/ML VIAL
(Insulin Aspart)
1 X 10ML VIALGL0016975011128
PDPs
251
MAPDs
NOVOLOG 100 UNIT/ML CARTRIDGE
(Insulin Aspart)
3 ML  0016933031228
PDPs
250
MAPDs
NOVOLOG FLEXPEN SYRINGE
(Insulin Aspart)
5 X 3ML SYR0016963391028
PDPs
250
MAPDs
NOVOLOG MIX 70/30 VIAL
(Insulin Aspart Prot & Aspart (Human))
1 VIAL0016936851228
PDPs
251
MAPDs
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML
(Insulin Aspart Prot & Aspart (Human))
5 X 3 ML SYR0016936961928
PDPs
250
MAPDs
OCTAGAM 10% VIAL
(Immune Globulin (Human) IV)
   6898208500135
PDPs
203
MAPDs
OCTAGAM 5% VIAL
(Immune Globulin (Human) IV)
   6898208400135
PDPs
201
MAPDs
ONMEL 200 MG TABLET
(itraconazole)
   0025914202810
PDPs
58
MAPDs
PALIPERIDONE ER 1.5 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839789355
PDPs
334
MAPDs
PALIPERIDONE ER 3 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839799355
PDPs
334
MAPDs
PALIPERIDONE ER 6 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839809355
PDPs
334
MAPDs
PALIPERIDONE ER 9 MG TABLET [INVEGA]
(Paliperidone Palmitate IM ER)
   0037839819355
PDPs
334
MAPDs
PHYSIOLYTE SOLUTION FOR IRRIGATION
(Irrigation Solution, Physiological)
1000 ML X 16 CASE0026422050019
PDPs
122
MAPDs
PHYSIOSOL IRRIGATION SOL
(Irrigation Solution, Physiological)
24 X 500 ML CTR0040961410319
PDPs
124
MAPDs
PICATO 0.015% GEL
(ingenol mebutate)
   5022205024732
PDPs
208
MAPDs
PICATO 0.05% GEL
(ingenol mebutate)
   5022205034732
PDPs
208
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
257
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  4408700220321
PDPs
204
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  4408700440321
PDPs
201
MAPDs
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL
(Interferon Beta-1a)
   4408788220121
PDPs
201
MAPDs
REBIF REBIDOSE TITRATION PACK
(Interferon Beta-1a)
4.2 ML  4408701880121
PDPs
191
MAPDs
REBIF REBIDOSE 22 MCG/0.5 ML
(Interferon Beta-1a)
0.5 ML  4408733220121
PDPs
191
MAPDs
REBIF REBIDOSE 44 MCG/0.5 ML
(Interferon Beta-1a)
0.5 ML  4408733440121
PDPs
192
MAPDs
REMICADE 100MG VIAL
(Infliximab For IV)
20 ML VIALSU5789400300156
PDPs
312
MAPDs
RIFAMATE 150/300 CAPSULE
(Isoniazid & Rifampin)
60 BOT000680509605
PDPs
80
MAPDs
RIFATER 50/300/120 TABLET
(Isoniazid-Rifampin w/ Pyrazinamide)
60 BOT0008805764143
PDPs
288
MAPDs
SKLICE 0.5% LOTION
(ivermectin)
117.000 GM  243380183046
PDPs
60
MAPDs
SOLIQUA 100 UNIT-33 MCG/ML PEN
(Insulin glargine and lixisenatide)
   000245761057
PDPs
24
MAPDs
SOOLANTRA 1% CREAM
(Ivermectin)
   0029938233012
PDPs
57
MAPDs
SPORANOX 10MG/ML SOLUTION
(Itraconazole)
150 ML BOT5045802951520
PDPs
124
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
6
MAPDs
TIVORBEX 40 MG CAPSULE
(Indomethacin)
   422110202292
PDPs
6
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  0002458690352
PDPs
281
MAPDs
TRESIBA FLEXTOUCH 100 UNITS/ML
(Insulin Degludec)
   0016926601524
PDPs
150
MAPDs
TRESIBA FLEXTOUCH 200 UNITS/ML
(Insulin Degludec)
   0016925501324
PDPs
150
MAPDs
Ventavis 0.01mg/mL
(Iloprost)
   6621503023049
PDPs
260
MAPDs
Ventavis 0.02mg/mL
(Iloprost)
   6621503033047
PDPs
257
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  0000323271157
PDPs
332
MAPDs
ZENATANE 10 MG CAPSULE
(Isotretinoin)
30 EA  5511101358139
PDPs
263
MAPDs
ZENATANE 20 MG CAPSULE
(Isotretinoin)
   5511101367939
PDPs
264
MAPDs
ZENATANE 30 MG CAPSULE
(Isotretinoin)
30 EA  5511101138140
PDPs
269
MAPDs
ZENATANE 40 MG CAPSULE
(Isotretinoin)
   5511101377939
PDPs
264
MAPDs
ZYCLARA 2.5% CREAM PUMP
(Imiquimod)
   992070276757
PDPs
114
MAPDs
ZYCLARA 3.75% CREAM
(Imiquimod)
28 EA  992070270287
PDPs
105
MAPDs
ZYDELIG 100 MG TABLET
(Idelalisib)
60 EA  6195817010157
PDPs
334
MAPDs
ZYDELIG 150 MG TABLET
(Idelalisib)
60 EA  6195817020157
PDPs
334
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data July 2017)


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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.
  • 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.
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