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2017 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:

Top Medicare Drugs (Short List) in Alphabetical Order

Drug Name
Packaging NDC On This Nbr of 2017 Formularies
PDPs MAPDs
ABILIFY 10MG TABLET
(Aripiprazole)
30 BOT 59148000813 5
PDPs
19
MAPDs
ABILIFY 15MG TABLET
(Aripiprazole)
30 BOT 59148000913 5
PDPs
19
MAPDs
ABILIFY 2MG TABLET
(Aripiprazole)
30 BOX 59148000613 5
PDPs
19
MAPDs
ABILIFY 20MG TABLET
(Aripiprazole)
30 BOT 59148001013 5
PDPs
19
MAPDs
ABILIFY 30MG TABLET
(Aripiprazole)
30 BOT 59148001113 5
PDPs
19
MAPDs
ABILIFY MAINTENA ER 300 MG SYR
(Aripiprazole)
    59148004580 59
PDPs
332
MAPDs
ABILIFY MAINTENA ER 300 MG VL
(Aripiprazole)
1 EA   59148001871 59
PDPs
338
MAPDs
ABILIFY MAINTENA ER 400 MG SYR
(Aripiprazole)
    59148007280 59
PDPs
334
MAPDs
ABILIFY 5MG TABLET (OTSUKA)
(Aripiprazole)
30 BOT 59148000713 5
PDPs
19
MAPDs
Actonel 150mg 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 1 FILM COATED TABLETS in TRAY
(Risedronate Sodium)
36 DOSE PACK in 1 CASE /   00430047801 2
PDPs
10
MAPDs
Actonel 30mg 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE
(Risedronate Sodium)
12 BOTTLE in 1 CASE / 30   00430047015 1
PDPs
16
MAPDs
Actonel 35mg 36 DOSE PACK CASE / 1 TRAY DOSE PACK / 4 FILM COATED TABLETS in TRAY
(Risedronate Sodium)
36 DOSE PACK in 1 CASE /   00430047203 1
PDPs
10
MAPDs
Actonel 5mg 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE
(Risedronate Sodium)
12 BOTTLE in 1 CASE / 30   00430047115 1
PDPs
10
MAPDs
ACTOS 15 MG TABLET
(Pioglitazone HCL)
    64764015104 6
PDPs
11
MAPDs
ACTOS 30 MG TABLET
(Pioglitazone HCL)
    64764030114 6
PDPs
11
MAPDs
ACTOS 45 MG TABLET
(Pioglitazone HCL)
    64764045124 6
PDPs
11
MAPDs
ADVAIR DISKUS MIS 100/50
(Fluticasone-Salmeterol)
60 DOSE INHL 00173069500 52
PDPs
329
MAPDs
ADVAIR DISKUS MIS 250/50
(Fluticasone-Salmeterol)
60 DOSE BLPK 00173069600 52
PDPs
329
MAPDs
ADVAIR DISKUS MIS 500/50
(Fluticasone-Salmeterol)
60 BLPK 00173069700 52
PDPs
329
MAPDs
AMLODIPINE BESYLATE 10MG TABLET (90 CT)
(Amlodipine Besylate)
90 BOT 65862010390 59
PDPs
341
MAPDs
AMLODIPINE-BENAZEPRIL 10-40 MG
(Amlodipine Besylate-Benazepril HCl)
100 EA   65862058701 51
PDPs
333
MAPDs
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE
(Amlodipine Besylate)
100 CAP BOT 00093737301 51
PDPs
333
MAPDs
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)
(Amlodipine Besylate)
90 BOT 65862010190 59
PDPs
341
MAPDs
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE
(Amlodipine Besylate)
100 CAP BOT 00093737001 51
PDPs
333
MAPDs
AMLODIPINE BESYLATE 5MG TABLET (90 CT)
(Amlodipine Besylate)
90 BOT 65862010290 59
PDPs
341
MAPDs
AMLODIPINE-BENAZEPRIL 5-40 MG
(Amlodipine Besylate-Benazepril HCl)
500 EA   65862058505 51
PDPs
333
MAPDs
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE
(Amlodipine Besylate)
100 CAPS BOT 00093737101 51
PDPs
333
MAPDs
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE
(Amlodipine Besylate)
100 CAP BOT 00093737201 51
PDPs
333
MAPDs
ATORVASTATIN 10 MG TABLET [Lipitor]
(Atorvastatin Calcium)
    00378395009 59
PDPs
341
MAPDs
ATORVASTATIN 20 MG TABLET [Lipitor]
(Atorvastatin Calcium)
    00378395109 59
PDPs
341
MAPDs
ATORVASTATIN 40 MG TABLET [Lipitor]
(Atorvastatin Calcium)
    00378395209 59
PDPs
341
MAPDs
ATORVASTATIN 80 MG TABLET [Lipitor]
(Atorvastatin Calcium)
    00378395309 59
PDPs
341
MAPDs
CLOPIDOGREL 300 MG TABLET [Plavix]
(Clopidogrel)
    55111067131 25
PDPs
205
MAPDs
CLOPIDOGREL 75 MG TABLET [Plavix]
(Clopidogrel)
30 EA   00093731456 59
PDPs
341
MAPDs
CRESTOR 10MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075190 25
PDPs
79
MAPDs
CRESTOR 20MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075290 25
PDPs
79
MAPDs
CRESTOR 40mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC
(Rosuvastatin Calcium)
30 TABLET, FILM COATED in   00310075430 25
PDPs
79
MAPDs
CRESTOR 5MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075590 25
PDPs
80
MAPDs
CYMBALTA 20MG CAPSULE
(Duloxetine HCl Enteric Coated Pellets)
60 BOT 00002323560 6
PDPs
12
MAPDs
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT)
(Duloxetine HCl Enteric Coated Pellets)
30 BOT 00002324030 6
PDPs
12
MAPDs
Cymbalta 60mg/1 1000 CAPSULE, DELAYED RELEASE in 1 BOTTLE
(Duloxetine HCl Enteric Coated Pellets)
1000 CAPSULE, DELAYED REL   00002327004 6
PDPs
12
MAPDs
DIOVAN HCT 160/12.5MG TABLET
(Valsartan)
90 BOT 00078031534 8
PDPs
14
MAPDs
DIOVAN HCT 320/12.5MG TABLET
(Valsartan)
90 BOT 00078047134 8
PDPs
14
MAPDs
DIOVAN HCT 80/12.5MG TABLET
(Valsartan)
90 BOT 00078031434 8
PDPs
14
MAPDs
DIOVAN 160MG TABLET
(Valsartan)
90 BOT 00078035934 6
PDPs
12
MAPDs
DIOVAN HCT 160/25MG TABLET
(Valsartan)
90 BOT 00078038334 8
PDPs
14
MAPDs
DIOVAN 320MG TABLET
(Valsartan)
90 BOT 00078036034 6
PDPs
12
MAPDs
DIOVAN HCT 320/25MG TABLET
(Valsartan)
90 BOT 00078047234 8
PDPs
14
MAPDs
DIOVAN 40MG TABLET
(Valsartan)
30 BOT 00078042315 6
PDPs
12
MAPDs
DIOVAN 80MG TABLET
(Valsartan)
90 BOX 00078035834 6
PDPs
12
MAPDs
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta]
()
    00093754206 59
PDPs
341
MAPDs
DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta]
()
90 EA   68180029509 59
PDPs
341
MAPDs
DULOXETINE HCL DR 40 MG CAPSULE [Cymbalta]
()
    68180029706 25
PDPs
225
MAPDs
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta]
()
1000 EA   68180029603 59
PDPs
341
MAPDs
ESCITALOPRAM 10 MG TABLET [Lexapro]
(Escitalopram)
    00093585101 59
PDPs
341
MAPDs
ESCITALOPRAM 20 MG TABLET [Lexapro]
(Escitalopram)
    00093585201 59
PDPs
341
MAPDs
ESCITALOPRAM 5 MG TABLET [Lexapro]
(Escitalopram)
    00093585001 59
PDPs
341
MAPDs
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro]
(Escitalopram)
    65162070588 59
PDPs
341
MAPDs
ESOMEPRAZOLE MAG DR 20 MG CAPSULE [Nexium]
()
    00093645098 41
PDPs
211
MAPDs
ESOMEPRAZOLE SODIUM 20 MG VIAL [Nexium]
()
1 EA   62756050844 47
PDPs
269
MAPDs
ESOMEPRAZOLE SODIUM 40 MG VIAL [Nexium]
()
1 EA   62756050944 49
PDPs
267
MAPDs
ESOMEPRAZOLE DR 49.3 MG CAPSULE [Nexium]
()
    00093645198 40
PDPs
210
MAPDs
Furosemide 10 ML 10 MG/ML Injection
(Furosemide)
    23155052144 59
PDPs
337
MAPDs
Furosemide 10mg/mL 10 CARTON in 1 CONTAINER / 1 SYRINGE, PLASTIC in 1 CARTON / 4 mL in 1 SYRINGE, P
(Furosemide)
10 CARTON in 1 CONTAINER   00409963104 56
PDPs
305
MAPDs
FUROSEMIDE 10MG/ML SOLUTION
(Furosemide)
120 ML BOT 00054329450 59
PDPs
329
MAPDs
FUROSEMIDE 20 MG TABLET
(Furosemide)
100 EA   63304062401 59
PDPs
341
MAPDs
FUROSEMIDE 40 MG TABLET
(Furosemide)
1000 EA   63304062510 59
PDPs
341
MAPDs
FUROSEMIDE 40MG/5ML TUBEX
(Furosemide)
500 ML BOT 00054329863 49
PDPs
291
MAPDs
FUROSEMIDE 80 MG TABLET
(Furosemide)
100 EA   00378023201 59
PDPs
341
MAPDs
Hydrocodone Acetaminophen 2.5-325
(Hydrocodone-Acetaminophen)
    13811065710 25
PDPs
231
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064301 26
PDPs
201
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064801 26
PDPs
204
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064901 26
PDPs
209
MAPDs
Hydrocodone Acetaminophen 325; 10mg/1; mg/1 500 TABLET BOTTLE
(Hydrocodone-Acetaminophen)
500 TABLET in 1 BOTTLE   53746011005 59
PDPs
341
MAPDs
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL
(Hydrocodone-Acetaminophen)
    64376064016 56
PDPs
290
MAPDs
JANUVIA TABLET 100MG (30 CT)
(Sitagliptin Phosphate)
30 BOT 00006027731 55
PDPs
334
MAPDs
JANUVIA 25MG TABLET
(Sitagliptin Phosphate)
30 BOT 00006022131 55
PDPs
334
MAPDs
JANUVIA 50MG TABLET
(Sitagliptin Phosphate)
90 BOT 00006011254 55
PDPs
334
MAPDs
LANTUS 100U/ML VIAL
(Insulin Glargine)
10 ML VIAL 00088222033 56
PDPs
337
MAPDs
LANTUS SOLOSTAR INJECTION
(Insulin Glargine)
3 ML X 5 CRTG CRTN 00088221905 56
PDPs
334
MAPDs
Levothyroxine 100 mcg tablet
(Levothyroxine Sodium)
    00378180977 59
PDPs
341
MAPDs
LEVOTHYROXINE 100 MCG VIAL
(Levothyroxine Sodium)
    63323064907 12
PDPs
94
MAPDs
LEVOTHYROXINE 112 MCG TABLET
(Levothyroxine Sodium)
90.000 EA   00378181177 59
PDPs
341
MAPDs
LEVOTHYROXINE 125 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378181310 59
PDPs
341
MAPDs
LEVOTHYROXINE 137 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378182310 59
PDPs
341
MAPDs
LEVOTHYROXINE 150 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378181510 59
PDPs
341
MAPDs
LEVOTHYROXINE 175 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378181710 59
PDPs
341
MAPDs
LEVOTHYROXINE 200 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378181910 59
PDPs
341
MAPDs
Levothyroxine 25 mcg tablet
(Levothyroxine Sodium)
    00378180077 59
PDPs
341
MAPDs
LEVOTHYROXINE 300 MCG TABLET
(Levothyroxine Sodium)
90 EA   00378182177 59
PDPs
341
MAPDs
LEVOTHYROXINE 50 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378180310 59
PDPs
341
MAPDs
LEVOTHYROXINE 75 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378180510 59
PDPs
341
MAPDs
LEVOTHYROXINE 88 MCG TABLET
(Levothyroxine Sodium)
90.000 EA   00378180777 59
PDPs
341
MAPDs
LEXAPRO 10MG TABLET
(Escitalopram Oxalate)
10 BOT 00456201001 4
PDPs
9
MAPDs
LEXAPRO 20MG TABLET
(Escitalopram Oxalate)
100 TABLETS BOT 00456202001 4
PDPs
9
MAPDs
LEXAPRO 5MG TABLET
(Escitalopram Oxalate)
100 BOT 00456200501 4
PDPs
9
MAPDs
LIPITOR 10MG TABLET
(Atorvastatin Calcium)
90 BOT 00071015523 7
PDPs
14
MAPDs
LIPITOR 20 MG TABLET
(Atorvastatin Calcium)
    00071015623 5
PDPs
12
MAPDs
LIPITOR 40MG TABLET (500 CT)
(Atorvastatin Calcium)
500 BOT 00071015773 5
PDPs
12
MAPDs
LIPITOR 80MG TABLET
(Atorvastatin Calcium)
500 BOT 00071015873 5
PDPs
12
MAPDs
LISINOPRIL 10MG TABLET (100 CT)
(Lisinopril)
100 BOT 00172375960 59
PDPs
341
MAPDs
Lisinopril with Hydrochlorothiazide 12.5; 10mg/1; mg/1 100 TABLET BOTTLE, PLASTIC
(Lisinopril)
100 TABLET in 1 BOTTLE, P   00143126201 59
PDPs
341
MAPDs
Lisinopril with Hydrochlorothiazide 12.5; 20mg/1; mg/1 100 TABLET BOTTLE, PLASTIC
(Lisinopril)
100 TABLET in 1 BOTTLE, P   00143126301 59
PDPs
341
MAPDs
LISINOPRIL 2.5 MG TABLET
(Lisinopril)
100 EA   00378207201 59
PDPs
341
MAPDs
LISINOPRIL 20 MG TABLET
(Lisinopril)
1000 EA   00378207510 59
PDPs
341
MAPDs
LISINOPRIL-HCTZ 20-25MG TABLET (100 CT)
(Lisinopril)
100 BOT 65862004501 59
PDPs
341
MAPDs
LISINOPRIL 30MG TABLET (100 CT)
(Lisinopril)
100 BOT 00591088501 59
PDPs
341
MAPDs
LISINOPRIL 40MG TABLET (500 CT)
(Lisinopril)
500 BOT 00591040905 59
PDPs
341
MAPDs
Lisinopril 5mg/1 1000 TABLET BOTTLE
(Lisinopril)
1000 TABLET in 1 BOTTLE   00603421032 59
PDPs
341
MAPDs
MEMANTINE HCL 10 MG TABLET [Namenda]
(Memantine HCl)
500 EA   55111059705 59
PDPs
341
MAPDs
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda]
(Memantine HCl)
    00527194313 58
PDPs
324
MAPDs
MEMANTINE HCL 5 MG TABLET [Namenda]
(Memantine HCl)
    55111059660 59
PDPs
341
MAPDs
Metformin HCL ER tab 1000mg
(Metformin HCl)
    68180033909 5
PDPs
42
MAPDs
METFORMIN HCL 1,000 MG TABLET
(Metformin HCl)
500 EA   43547035950 59
PDPs
341
MAPDs
METFORMIN ER 1,000 MG OSM-TAB
(Metformin HCl)
60 EA   00378600191 17
PDPs
128
MAPDs
24 HR Metformin hydrochloride 500 MG Extended Release Oral Tablet
(Metformin HCl)
    00378600291 21
PDPs
129
MAPDs
Metformin hcl 500 mg tablet
(Metformin HCl)
    23155010205 59
PDPs
341
MAPDs
Metformin HCL ER tab 500mg
(Metformin HCl)
    68180033801 9
PDPs
51
MAPDs
METFORMIN HCL ER 500 MG TABLET
(Metformin HCl)
100 EA   60505026001 59
PDPs
341
MAPDs
Metformin Hydrochloride 750mg/1
(Metformin HCl)
    60505132901 59
PDPs
341
MAPDs
METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE
(Metformin HCl)
100 TABLET in 1 BOTTLE   57664043551 59
PDPs
341
MAPDs
Metoprolol Tartrate 1mg/mL 3 AMPULE in 1 CARTON / 5 mL in 1 AMPULE
(Metoprolol Tartrate)
3 AMPULE in 1 CARTON / 5   00409228505 48
PDPs
281
MAPDs
METOPROLOL TARTRATE 100 MG TAB
(Metoprolol Tartrate)
1000 EA   00378004710 59
PDPs
341
MAPDs
METOPROLOL TARTRATE 25MG TABLET (100 CT)
(Metoprolol Tartrate)
100 BOT 65862006201 59
PDPs
341
MAPDs
METOPROLOL TARTRATE INJ.USP 5MG/5ML CARPUJECT
(Metoprolol Tartrate)
    00409177835 45
PDPs
245
MAPDs
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT)
(Metoprolol Tartrate)
1000 BOT 00378003210 59
PDPs
341
MAPDs
NAMENDA XR TITRATION PACK
(Memantine HCl)
    00456340029 47
PDPs
275
MAPDs
NAMENDA 10MG TABLET
(Memantine HCl)
60 BOT 00456321060 10
PDPs
65
MAPDs
NAMENDA XR 14 MG CAPSULE
(Memantine HCl)
30 EA   00456341433 47
PDPs
273
MAPDs
NAMENDA XR 21 MG CAPSULE
(Memantine HCl)
    00456342133 47
PDPs
273
MAPDs
NAMENDA XR 28 MG CAPSULE
(Memantine HCl)
    00456342890 47
PDPs
273
MAPDs
NAMENDA 5MG TABLET
(Memantine HCl)
60 BOT 00456320560 10
PDPs
65
MAPDs
NAMENDA 5-10MG TITRATION PK
(Memantine HCl)
49 COUNT 00456320014 10
PDPs
70
MAPDs
NAMENDA XR 7 MG CAPSULE
(Memantine HCl)
    00456340733 47
PDPs
273
MAPDs
NEXIUM 10mg/1 30 GRANULE, DELAYED RELEASE per CARTON
(Esomeprazole Magnesium)
30 GRANULE, DELAYED RELEA   00186401001 31
PDPs
118
MAPDs
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)
20 MG PKT X 30 PKT 00186402001 31
PDPs
120
MAPDs
NEXIUM 20MG CAPSULE
(Esomeprazole Magnesium)
90 BOT 00186502054 18
PDPs
15
MAPDs
NEXIUM DR 2.5 MG PACKET
(Esomeprazole Magnesium)
    00186402501 32
PDPs
120
MAPDs
NEXIUM IV 40MG VIAL
(Esomeprazole Magnesium)
10 VIALSD 00186604001 5
PDPs
18
MAPDs
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)
40 MG PKT X 30 PKT 00186404001 31
PDPs
120
MAPDs
NEXIUM 40MG CAPSULE
(Esomeprazole Magnesium)
90 BOT 00186504054 18
PDPs
15
MAPDs
NEXIUM DR 5 MG PACKET
(Esomeprazole Magnesium)
    00186405001 32
PDPs
120
MAPDs
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT)
(Omeprazole)
30 BOT 00378521193 59
PDPs
340
MAPDs
Omeprazole 20mg DELAYED RELEASE 100 CAPSULE BOTTLE
(Omeprazole)
100 CAPSULE BOTTLE   00378615001 59
PDPs
341
MAPDs
OMEPRAZOLE-BICARB 20-1,100 CAP
(Omeprazole)
30 EA   16714050801 8
PDPs
62
MAPDs
Omeprazole-bicarb 20-1,680 pkt
(Omeprazole)
    27241002962 7
PDPs
64
MAPDs
OMEPRAZOLE CAPSULES DELAYED RELEASE 40 MG
(Omeprazole)
30 BOT 62175013632 59
PDPs
339
MAPDs
OMEPRAZOLE-BICARB 40-1,100 CAP
(Omeprazole)
30 EA   13107011630 8
PDPs
62
MAPDs
Omeprazole-bicarb 40-1,680 pkt
(Omeprazole)
    27241003062 7
PDPs
63
MAPDs
pioglitazone hcl 15 mg tablet [Actos]
(Pioglitazone HCL)
    00378004877 59
PDPs
341
MAPDs
pioglitazone hcl 30 mg tablet [Actos]
(Pioglitazone HCL)
    00378022893 59
PDPs
341
MAPDs
pioglitazone hcl 45 mg tablet [Actos]
(Pioglitazone HCL)
    00378031877 59
PDPs
341
MAPDs
PLAVIX TABLETS 300MG
(Clopidogrel Bisulfate)
    63653133202 2
PDPs
6
MAPDs
PLAVIX 75 MG TABLET
(Clopidogrel Bisulfate)
90.000 EA   63653117101 5
PDPs
9
MAPDs
QUETIAPINE FUMARATE 100 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090488 59
PDPs
341
MAPDs
24 HR Quetiapine 150 MG Extended Release Oral Tablet [Seroquel]
(Quetiapine Fumarate)
    00406118160 44
PDPs
307
MAPDs
24 HR Quetiapine 200 MG Extended Release Oral Tablet [Seroquel]
(Quetiapine Fumarate)
    00406118260 44
PDPs
307
MAPDs
QUETIAPINE FUMARATE 200 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090588 59
PDPs
341
MAPDs
QUETIAPINE FUMARATE 25 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090288 59
PDPs
341
MAPDs
24 HR Quetiapine 300 MG Extended Release Oral Tablet [Seroquel]
(Quetiapine Fumarate)
    52817016360 44
PDPs
307
MAPDs
QUETIAPINE FUMARATE 300 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090688 59
PDPs
341
MAPDs
QUETIAPINE FUMARATE 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090788 59
PDPs
341
MAPDs
QUETIAPINE ER 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)
60.000 EA   16729009712 45
PDPs
307
MAPDs
24 HR Quetiapine 50 MG Extended Release Oral Tablet [Seroquel]
(Quetiapine Fumarate)
    00406118060 44
PDPs
307
MAPDs
QUETIAPINE FUMARATE 50 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100 EA   47335090388 59
PDPs
341
MAPDs
REVLIMID 10MG CAPSULE (100 CT)
(Lenalidomide)
100 BOT 59572041000 59
PDPs
341
MAPDs
REVLIMID 15MG CAPSULE 21 BOT
(Lenalidomide)
21 BOT 59572041521 59
PDPs
341
MAPDs
REVLIMID 2.5 MG CAPSULE
(Lenalidomide)
100 EA   59572040200 59
PDPs
341
MAPDs
REVLIMID 20 MG CAPSULE
(Lenalidomide)
100 EA   59572042000 59
PDPs
341
MAPDs
REVLIMID 25MG CAPSULE (100 CT)
(Lenalidomide)
100 BOT 59572042500 59
PDPs
341
MAPDs
REVLIMID 5MG CAPSULE
(Lenalidomide)
100 BOT 59572040500 59
PDPs
341
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
4 EA   47335066868 26
PDPs
233
MAPDs
RISEDRONATE SODIUM 150 MG TABLET [Actonel]
(Risedronate Sodium)
    00378415032 28
PDPs
257
MAPDs
RISEDRONATE SODIUM 30 MG TABLET [Actonel]
(Risedronate Sodium)
30 EA   00093310056 29
PDPs
235
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
    00093309844 27
PDPs
219
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
12 EA   00093309829 27
PDPs
220
MAPDs
RISEDRONATE SODIUM DR 35 MG TABLET [Actonel]
(Risedronate Sodium)
4 EA   00093550944 26
PDPs
165
MAPDs
RISEDRONATE SODIUM 5 MG TABLET [Actonel]
(Risedronate Sodium)
30 EA   00093309956 28
PDPs
235
MAPDs
ROSUVASTATIN CALCIUM 10 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 EA   16252061690 54
PDPs
331
MAPDs
ROSUVASTATIN CALCIUM 20 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 EA   16252061790 54
PDPs
331
MAPDs
Rosuvastatin calcium 40 MG TABLET [Crestor]
(Rosuvastatin Calcium)
    16252061830 54
PDPs
331
MAPDs
ROSUVASTATIN CALCIUM 5 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 EA   16252061590 54
PDPs
331
MAPDs
SEROQUEL 100MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027110 4
PDPs
9
MAPDs
SEROQUEL 200MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027210 4
PDPs
9
MAPDs
SEROQUEL 25MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027510 4
PDPs
9
MAPDs
SEROQUEL 300MG TABLET
(Quetiapine Fumarate)
60 BOT 00310027460 4
PDPs
9
MAPDs
SEROQUEL 400MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027910 4
PDPs
9
MAPDs
SEROQUEL 50MG TABLET (100 CT)
(Quetiapine Fumarate)
100 BOT 00310027810 4
PDPs
9
MAPDs
SEROQUEL TABLETS EXTENDED RELEASE 150MG 100 CRTN
(Quetiapine Fumarate)
100 CRTN 00310028139 29
PDPs
151
MAPDs
SEROQUEL TABLETS EXTENDED RELEASE 200MG 100 X 200 MG CRTN
(Quetiapine Fumarate)
100 X 200 MG CRTN 00310028239 29
PDPs
152
MAPDs
SEROQUEL XR 300MG TABLET 60X300MG BOT
(Quetiapine Fumarate)
60 X 300 MG BOT 00310028360 29
PDPs
152
MAPDs
SEROQUEL TABLETS EXTENDED RELEASE 400MG 100 X 400 MG CRTN
(Quetiapine Fumarate)
100 X 400 MG CRTN 00310028439 29
PDPs
149
MAPDs
SEROQUEL TABLETS EXTENDED RELEASE 50MG 100 TABS CRTN
(Quetiapine Fumarate)
100 TABS CRTN 00310028039 29
PDPs
151
MAPDs
SPIRIVA RESPIMAT INHAL SPRAY
(Tiotropium Bromide Monohydrate)
4 GM   00597010061 42
PDPs
279
MAPDs
VALSARTAN 160 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
90 EA   51660014290 59
PDPs
340
MAPDs
VALSARTAN 320 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
90 EA   51660014390 59
PDPs
340
MAPDs
VALSARTAN 40 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
30 EA   51660014030 59
PDPs
340
MAPDs
VALSARTAN 80 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
90 EA   51660014190 59
PDPs
340
MAPDs
VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
500 EA   00378632205 57
PDPs
335
MAPDs
VALSARTAN-HCTZ 160-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
90 EA   00378632377 57
PDPs
335
MAPDs
VALSARTAN-HCTZ 320-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
500 EA   00378632405 57
PDPs
335
MAPDs
VALSARTAN-HCTZ 320-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
500 EA   00378632505 57
PDPs
335
MAPDs
VALSARTAN-HCTZ 80-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
90 EA   00378632177 57
PDPs
335
MAPDs



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


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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • 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.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • 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.