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2021 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:
Links to Summaries by State for LTC Drugs on LIS/SNP Plans:
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Top Medicare Drugs (Long List) in Alphabetical Order

Drug Name
Packaging NDC On This Nbr of 2021 Formularies
PDPs MAPDs
ABILIFY 10MG TABLET
(Aripiprazole)
30 BOT 59148000813 3
PDPs
9
MAPDs
ABILIFY 15MG TABLET
(Aripiprazole)
30 BOT 59148000913 3
PDPs
9
MAPDs
ABILIFY 20MG TABLET
(Aripiprazole)
30 BOT 59148001013 3
PDPs
9
MAPDs
ABILIFY 2MG TABLET
(Aripiprazole)
30 BOX 59148000613 3
PDPs
9
MAPDs
ABILIFY 30MG TABLET
(Aripiprazole)
30 BOT 59148001113 3
PDPs
9
MAPDs
ABILIFY 5 MG TABLET
(Aripiprazole)
30 tablets BOT 59148000713 3
PDPs
9
MAPDs
ACTIQ 400MCG LOZENGE
(Fentanyl Citrate)
30 BOT 63459050430 0
PDPs
5
MAPDs
ACTONEL 150 MG TABLET
(Risedronate)
1 tablet   00430047801 2
PDPs
1
MAPDs
ACTONEL 35 MG TABLET
(Risedronate)
4 tablets   00430047203 2
PDPs
1
MAPDs
ACTOPLUS MET 15MG/500MG TABLET
(Pioglitazone HCl-Metformin HCl)
60 BOT 64764015560 0
PDPs
1
MAPDs
ACTOS 15 MG TABLET
(Pioglitazone HCL)
    64764015104 3
PDPs
10
MAPDs
ACTOS 30 MG TABLET
(Pioglitazone HCL)
    64764030114 3
PDPs
10
MAPDs
ACTOS 45 MG TABLET
(Pioglitazone HCL)
    64764045124 3
PDPs
10
MAPDs
ADDERALL XR 20MG CAPSULE SA
(Amphetamine-Dextroamphetamine)
100 BOT 54092038701 3
PDPs
10
MAPDs
ADVAIR DISKUS MIS 100/50
(Fluticasone-Salmeterol)
60 DOSE INHL 00173069500 51
PDPs
242
MAPDs
ADVAIR DISKUS MIS 250/50
(Fluticasone-Salmeterol)
60 DOSE BLPK 00173069600 51
PDPs
242
MAPDs
ADVAIR DISKUS MIS 500/50
(Fluticasone-Salmeterol)
60 BLPK 00173069700 51
PDPs
242
MAPDs
ALTACE 10MG CAPSULE (100 CT)
(Ramipril)
100 CAPS BOTPL 61570012001 3
PDPs
10
MAPDs
ANDROGEL 1% (50MG) GEL PACKET
(Testosterone)
3O X 5GM PKT CRTN 00051845030 3
PDPs
8
MAPDs
ARICEPT 10MG TABLET
(Donepezil HCL)
30 BOT 62856024630 3
PDPs
8
MAPDs
ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify]
(Aripiprazole)
30 mls   65162089374 68
PDPs
397
MAPDs
ARIPIPRAZOLE 10 MG TABLET [Abilify]
(Aripiprazole)
30 tablets   13668021830 68
PDPs
397
MAPDs
ARIPIPRAZOLE 15 MG TABLET [Abilify]
(Aripiprazole)
30 TABLETS   13668021930 68
PDPs
397
MAPDs
ARIPIPRAZOLE 2 MG TABLET [Abilify]
(Aripiprazole)
30 tablets   13668021630 68
PDPs
397
MAPDs
ARIPIPRAZOLE 20 MG TABLET [Abilify]
(Aripiprazole)
30 tablets   13668022030 68
PDPs
397
MAPDs
ARIPIPRAZOLE 30 MG TABLET [Abilify]
(Aripiprazole)
30 TABLETS   13668022130 68
PDPs
397
MAPDs
ARIPIPRAZOLE 5 MG TABLET [Abilify]
(Aripiprazole)
30 tablets   13668021730 68
PDPs
397
MAPDs
ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt]
(Aripiprazole)
30 units   62332010330 68
PDPs
397
MAPDs
ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt]
(Aripiprazole)
units   62332010430 68
PDPs
394
MAPDs
ATORVASTATIN 10 MG TABLET [Lipitor]
(Atorvastatin Calcium)
1000.000 EA   60505257808 68
PDPs
397
MAPDs
ATORVASTATIN 20 MG TABLET [Lipitor]
(Atorvastatin Calcium)
1000.000 EA   60505257908 68
PDPs
397
MAPDs
ATORVASTATIN 40 MG TABLET [Lipitor]
(Atorvastatin Calcium)
1000 EA   60505258008 68
PDPs
397
MAPDs
ATORVASTATIN 80 MG TABLET [Lipitor]
(Atorvastatin Calcium)
30 tablets   60505267108 68
PDPs
397
MAPDs
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC
(Efavirenz-Emtricitabine-Tenofovir DF)
30 TABLET, FILM COATED   15584010101 36
PDPs
135
MAPDs
CLARINEX 5 MG TABLET
(Desloratadine)
100 BOT 00085126401 0
PDPs
1
MAPDs
CLOPIDOGREL 75 MG TABLET [Plavix]
(Clopidogrel)
30 TABLETS   16729021816 68
PDPs
397
MAPDs
CRESTOR 10MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075190 3
PDPs
8
MAPDs
CRESTOR 20MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075290 3
PDPs
8
MAPDs
CRESTOR 40mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC
(Rosuvastatin Calcium)
30 TABLET, FILM COATED   00310075430 3
PDPs
8
MAPDs
CRESTOR 5MG TABLET
(Rosuvastatin Calcium)
90 BOT 00310075590 3
PDPs
8
MAPDs
CYMBALTA 20MG CAPSULE
(Duloxetine HCl Enteric Coated Pellets)
60 BOT 00002323560 3
PDPs
8
MAPDs
CYMBALTA 60 MG CAPSULE
(Duloxetine HCl Enteric Coated Pellets)
30.000 EA   00002327030 3
PDPs
8
MAPDs
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT)
(Duloxetine HCl Enteric Coated Pellets)
30 BOT 00002324030 3
PDPs
8
MAPDs
DEPAKOTE ER 500MG TABLET
(Divalproex Sodium)
100 BOT 00074712613 3
PDPs
9
MAPDs
DIOVAN 160MG TABLET
(Valsartan)
90 BOT 00078035934 3
PDPs
10
MAPDs
DIOVAN 320MG TABLET
(Valsartan)
90 BOT 00078036034 3
PDPs
10
MAPDs
DIOVAN 40MG TABLET
(Valsartan)
30 BOT 00078042315 3
PDPs
10
MAPDs
DIOVAN 80MG TABLET
(Valsartan)
90 BOX 00078035834 3
PDPs
10
MAPDs
DIOVAN HCT 160/12.5MG TABLET
(Valsartan)
90 BOT 00078031534 3
PDPs
10
MAPDs
DIOVAN HCT 160/25MG TABLET
(Valsartan)
90 BOT 00078038334 3
PDPs
10
MAPDs
DIOVAN HCT 320/12.5MG TABLET
(Valsartan)
90 BOT 00078047134 3
PDPs
10
MAPDs
DIOVAN HCT 320/25MG TABLET
(Valsartan)
90 BOT 00078047234 3
PDPs
10
MAPDs
DIOVAN HCT 80/12.5MG TABLET
(Valsartan)
90 BOT 00078031434 3
PDPs
10
MAPDs
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta]
(Duloxetine)
30 units   57237001760 68
PDPs
397
MAPDs
DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta]
(Duloxetine)
30 units   57237001830 68
PDPs
397
MAPDs
DULOXETINE HCL DR 40 MG CAPSULE [Irenka]
(Duloxetine)
30 units   68180029706 16
PDPs
209
MAPDs
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta]
(Duloxetine)
30 units   57237001930 68
PDPs
397
MAPDs
ENDOCET 5/325 TABLET
(Oxycodone w/ Acetaminophen)
500 BOT 60951060285 68
PDPs
388
MAPDs
ESCITALOPRAM 10 MG TABLET [Lexapro]
(Escitalopram)
100.000 EA   16729016901 68
PDPs
397
MAPDs
ESCITALOPRAM 20 MG TABLET [Lexapro]
(Escitalopram)
100.000 EA   16729017001 68
PDPs
397
MAPDs
ESCITALOPRAM 5 MG TABLET [Lexapro]
(Escitalopram)
30 TABLETS   13668013501 68
PDPs
397
MAPDs
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro]
(Escitalopram)
240 ML   31722056924 68
PDPs
397
MAPDs
ESOMEPRAZOLE DR 10 MG SUSPDR PACKET [Nexium]
(Esomeprazole)
30 UNITS   69097052734 10
PDPs
93
MAPDs
ESOMEPRAZOLE DR 20 MG SUSPDR PACKET [Nexium]
(Esomeprazole)
30 UNITS   69097052834 10
PDPs
93
MAPDs
ESOMEPRAZOLE DR 40 MG SUSPDR PACKET [Nexium]
(Esomeprazole)
30 UNITS   69097052934 10
PDPs
93
MAPDs
ESOMEPRAZOLE MAG DR 20 MG CAPSULE [Nexium]
()
30 EA   00378235093 50
PDPs
330
MAPDs
ESOMEPRAZOLE MAG DR 40 MG CAPSULE [Nexium]
()
30.000 EA   00378235193 50
PDPs
330
MAPDs
FEMARA 2.5MG TABLET
(Letrozole)
30 BOT 00078024915 3
PDPs
8
MAPDs
FENTORA TABLET 100MCG
(Fentanyl Citrate)
28 BLPK 63459054128 1
PDPs
58
MAPDs
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER
(Fluticasone Propionate HFA)
120 AEROSOL, METERED   00173071920 64
PDPs
369
MAPDs
FOCALIN XR 5 MG CAPSULE
(Dexmethylphenidate HCl)
100 BOT 00078043005 0
PDPs
1
MAPDs
FOSAMAX 70MG TABLET
(Alendronate Sodium)
4 BLPK 00006003144 3
PDPs
8
MAPDs
FOSAMAX PLUS D 70; 5600mg/1; [iU]/1 4 TABLET per BLISTER PACK
(Alendronate Sodium-Cholecalciferol)
4 TABLET in BLISTER PACK   00006027044 2
PDPs
58
MAPDs
FUROSEMIDE 10 MG/ML SOLUTION
(Furosemide)
60.000 ML   00054329446 68
PDPs
392
MAPDs
FUROSEMIDE 100 MG/10 ML VIAL
(Furosemide)
3 MLS   36000028425 67
PDPs
396
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 68
PDPs
378
MAPDs
FUROSEMIDE 20 MG TABLET [Lasix]
(Furosemide)
30 TABLETS   00054429725 68
PDPs
397
MAPDs
FUROSEMIDE 40 MG TABLET [Lasix]
(Furosemide)
30 TABLETS   69315011710 68
PDPs
397
MAPDs
FUROSEMIDE 40MG/5ML TUBEX
(Furosemide)
500 ML BOT 00054329863 48
PDPs
344
MAPDs
FUROSEMIDE 80 MG TABLET [Lasix]
(Furosemide)
30 TABLETS   43547040350 68
PDPs
397
MAPDs
Humira 2 KIT per CARTON / 1 KIT in 1 KIT
(Adalimumab)
2 KIT in 1 CARTON / 1 KIT   00074379902 68
PDPs
397
MAPDs
HUMIRA 40 MG/0.8 ML PEN
(ADALIMUMAB)
2 EA   00074433902 68
PDPs
394
MAPDs
HUMULIN 70/30 VIAL
(Insulin Isophane & Regular (Human))
1 X 10 ML VIAL 00002871501 43
PDPs
158
MAPDs
HUMULIN N 100U/ML VIAL
(Insulin Isophane (Human))
10 ML VIAL 00002831501 43
PDPs
158
MAPDs
HYDROCODON-ACETAMINOPH 7.5-325
(Hydrocodone-Acetaminophen)
100.000 EA   00406012401 68
PDPs
397
MAPDs
HYDROCODON-ACETAMINOPHEN 5-325
(Hydrocodone-Acetaminophen)
100.000 EA   00406012301 68
PDPs
397
MAPDs
HYDROCODONE-ACETAMIN 10-325 MG TABLET [Norco]
(Hydrocodone Bitartrate, Acetaminophen)
120 tablets   00406012501 68
PDPs
397
MAPDs
HYDROCODONE-ACETAMN 7.5-325/15 SOLUTION [Hycet]
(Hydrocodone Bitartrate, Acetaminophen)
120 mls   00121077216 64
PDPs
372
MAPDs
ISENTRESS 400MG TABLET
(Raltegravir Potassium)
60 BOT 00006022761 68
PDPs
397
MAPDs
JANUVIA 25MG TABLET
(Sitagliptin Phosphate)
30 BOT 00006022131 64
PDPs
381
MAPDs
JANUVIA 50 MG TABLET
(Sitagliptin Phosphate)
30.000 EA   00006011231 64
PDPs
381
MAPDs
JANUVIA TABLET 100MG (30 CT)
(Sitagliptin Phosphate)
30 BOT 00006027731 64
PDPs
381
MAPDs
KALETRA 50-200MG TABLET
(Lopinavir-Ritonavir)
120 BOT 00074679922 68
PDPs
397
MAPDs
KEPPRA 500MG TABLET
(Levetiracetam)
120 TABS BOT 50474059540 3
PDPs
8
MAPDs
LAMICTAL 100MG TABLET
(Lamotrigine)
100 BOT 00173064255 3
PDPs
8
MAPDs
LANTUS 100U/ML VIAL
(Insulin Glargine)
10 ML VIAL 00088222033 56
PDPs
316
MAPDs
LANTUS SOLOSTAR INJECTION
(Insulin Glargine)
3 ML X 5 CRTG CRTN 00088221905 56
PDPs
316
MAPDs
LEVOTHYROXINE 100 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378180910 68
PDPs
397
MAPDs
LEVOTHYROXINE 112 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378181110 68
PDPs
397
MAPDs
LEVOTHYROXINE 125 MCG TABLET
(Levothyroxine Sodium)
90 EA   00378181377 68
PDPs
397
MAPDs
LEVOTHYROXINE 137 MCG TABLET
(Levothyroxine Sodium)
90 EA   00378182377 68
PDPs
397
MAPDs
LEVOTHYROXINE 150 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378181510 68
PDPs
397
MAPDs
LEVOTHYROXINE 175 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378181710 68
PDPs
397
MAPDs
LEVOTHYROXINE 200 MCG TABLET
(Levothyroxine Sodium)
    00378181977 68
PDPs
397
MAPDs
LEVOTHYROXINE 25 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378180010 68
PDPs
397
MAPDs
LEVOTHYROXINE 300 MCG TABLET
(Levothyroxine Sodium)
90 EA   00378182177 68
PDPs
397
MAPDs
LEVOTHYROXINE 50 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378180310 68
PDPs
397
MAPDs
LEVOTHYROXINE 75 MCG TABLET
(Levothyroxine Sodium)
1000 EA   00378180510 68
PDPs
397
MAPDs
LEVOTHYROXINE 88 MCG TABLET
(Levothyroxine Sodium)
1000.000 EA   00378180710 68
PDPs
397
MAPDs
LEXAPRO 10MG TABLET
(Escitalopram Oxalate)
10 BOT 00456201001 3
PDPs
10
MAPDs
LEXAPRO 20MG TABLET
(Escitalopram Oxalate)
100 TABLETS BOT 00456202001 3
PDPs
10
MAPDs
LEXAPRO 5MG TABLET
(Escitalopram Oxalate)
100 BOT 00456200501 3
PDPs
10
MAPDs
LIPITOR 10MG TABLET
(Atorvastatin Calcium)
90 BOT 00071015523 3
PDPs
8
MAPDs
LIPITOR 20 MG TABLET
(Atorvastatin Calcium)
    00071015623 3
PDPs
8
MAPDs
LIPITOR 40 MG TABLET
(Atorvastatin Calcium)
90.000 EA   00071015723 3
PDPs
8
MAPDs
LIPITOR 80 MG TABLET
(Atorvastatin Calcium)
90.000 EA   00071015823 3
PDPs
8
MAPDs
LISINOPRIL 10 MG TABLET
(Lisinopril)
1000 EA   68180098003 68
PDPs
397
MAPDs
LISINOPRIL 2.5 MG TABLET
(Lisinopril)
500.000 EA   68180051202 68
PDPs
397
MAPDs
LISINOPRIL 20 MG TABLET
(Lisinopril)
1000 EA   68180098103 68
PDPs
397
MAPDs
LISINOPRIL 30 MG TABLET
(Lisinopril)
100 EA   68180098201 68
PDPs
397
MAPDs
LISINOPRIL 40 MG TABLET
(Lisinopril)
1000.000 EA   68180051703 68
PDPs
397
MAPDs
LISINOPRIL 5 MG TABLET
(Lisinopril)
1000.000 EA   68180051303 68
PDPs
397
MAPDs
LISINOPRIL-HCTZ 10-12.5 MG TABLET
(Lisinopril)
500.000 EA   68180051802 68
PDPs
397
MAPDs
LISINOPRIL-HCTZ 20-12.5 MG TABLET
(Lisinopril)
500.000 EA   68180051902 68
PDPs
397
MAPDs
LISINOPRIL-HCTZ 20-25 MG TABLET
(Lisinopril)
500.000 EA   68180052002 68
PDPs
397
MAPDs
LYRICA 50MG CAPSULE
(Pregabalin)
90 BOT 00071101368 3
PDPs
10
MAPDs
MEMANTINE HCL 10 MG TABLET [Namenda]
(Memantine HCl)
60 tablets   29300017216 68
PDPs
397
MAPDs
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda]
(Memantine HCl)
    00527194313 68
PDPs
388
MAPDs
MEMANTINE HCL 5 MG TABLET [Namenda]
(Memantine HCl)
60 tablets   29300017116 68
PDPs
397
MAPDs
METFORMIN HCL 1,000 MG TABLET
(Metformin HCl)
1000.000 EA   23155010410 68
PDPs
397
MAPDs
METFORMIN HCL 500 MG TABLET
(Metformin HCl)
1000.000 EA   23155010210 68
PDPs
397
MAPDs
METOPROLOL TARTRATE 25 MG TABLET
(Metoprolol Tartrate)
500.000 EA   00378001805 68
PDPs
397
MAPDs
METOPROLOL TARTRATE 37.5 MG TABLET
(Metoprolol Tartrate)
60 TABLETS   00378459301 25
PDPs
135
MAPDs
METOPROLOL TARTRATE 75 MG TABLET
(Metoprolol Tartrate)
60 TABLETS   00378459401 25
PDPs
137
MAPDs
MICARDIS 80MG TABLET
(Telmisartan)
3 X 10 BLPK 00597004137 3
PDPs
10
MAPDs
MICARDIS HCT 80/12.5MG TABLET
(Telmisartan-Hydrochlorothiazide)
3 X 10 BLPK 00597004437 3
PDPs
10
MAPDs
NAMENDA 10MG TABLET
(Memantine HCl)
60 BOT 00456321060 3
PDPs
8
MAPDs
NAMENDA 5-10MG TITRATION PK
(Memantine HCl)
49 COUNT 00456320014 5
PDPs
11
MAPDs
NAMENDA 5MG TABLET
(Memantine HCl)
60 BOT 00456320560 3
PDPs
8
MAPDs
NAMENDA XR 14 MG CAPSULE
(Memantine HCl)
30 EA   00456341433 0
PDPs
4
MAPDs
NAMENDA XR 21 MG CAPSULE
(Memantine HCl)
    00456342133 0
PDPs
4
MAPDs
NAMENDA XR 28 MG CAPSULE
(Memantine HCl)
30.000 EA   00456342833 0
PDPs
4
MAPDs
NAMENDA XR 7 MG CAPSULE
(Memantine HCl)
    00456340733 0
PDPs
4
MAPDs
NEXIUM 10mg/1 30 GRANULE, DELAYED RELEASE per CARTON
(Esomeprazole Magnesium)
30 GRANULE, DELAYED RELEA   00186401001 3
PDPs
21
MAPDs
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)
20 MG PKT X 30 PKT 00186402001 3
PDPs
44
MAPDs
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)
40 MG PKT X 30 PKT 00186404001 3
PDPs
44
MAPDs
NEXIUM DR 2.5 MG PACKET
(Esomeprazole Magnesium)
    00186402501 8
PDPs
58
MAPDs
NEXIUM DR 20 MG CAPSULE
(Esomeprazole Magnesium)
30.000 EA   00186502031 3
PDPs
8
MAPDs
NEXIUM DR 40 MG CAPSULE
(Esomeprazole Magnesium)
30.000 EA   00186504031 3
PDPs
8
MAPDs
NEXIUM DR 5 MG PACKET
(Esomeprazole Magnesium)
    00186405001 8
PDPs
58
MAPDs
NUVARING 0.12-0.015 RING VAGINAL
(Etonogestrel-Ethinyl Estradiol VA)
3 POU 00052027303 3
PDPs
31
MAPDs
OCELLA 3MG/0.03MG TABLET
(Drospirenone-Ethinyl Estradiol)
3 X 28 PKG 00555913167 60
PDPs
306
MAPDs
PIOGLITAZONE HCL 15 MG TABLET [Actos]
(Pioglitazone HCL)
30 tablets   16729002015 68
PDPs
397
MAPDs
PIOGLITAZONE HCL 30 MG TABLET [Actos]
(Pioglitazone HCL)
30 tablets   16729002115 68
PDPs
397
MAPDs
PIOGLITAZONE HCL 45 MG TABLET [Actos]
(Pioglitazone HCL)
30 tablets   16729002215 68
PDPs
397
MAPDs
PLAVIX 75 MG TABLET
(Clopidogrel Bisulfate)
30 TABLETs   63653117101 3
PDPs
8
MAPDs
QUETIAPINE ER 150 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)
30 tablets   16729010912 49
PDPs
347
MAPDs
QUETIAPINE ER 200 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)
30 tablets   16729009512 49
PDPs
347
MAPDs
QUETIAPINE ER 300 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)
30 tablets   16729009612 49
PDPs
347
MAPDs
QUETIAPINE ER 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)
60.000 EA   16729009712 49
PDPs
347
MAPDs
QUETIAPINE ER 50 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)
30 TABLETS   68180061207 49
PDPs
347
MAPDs
QUETIAPINE FUMARATE 100 MG TABLET [Seroquel]
(Quetiapine Fumarate)
30 TABLETS   67877025001 68
PDPs
397
MAPDs
QUETIAPINE FUMARATE 200 MG TABLET [Seroquel]
(Quetiapine Fumarate)
30 TABLETS   67877024601 68
PDPs
397
MAPDs
QUETIAPINE FUMARATE 25 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100.000 EA   16729014501 68
PDPs
397
MAPDs
QUETIAPINE FUMARATE 300 MG TABLET [Seroquel]
(Quetiapine Fumarate)
30 TABLETS   67877024760 68
PDPs
397
MAPDs
QUETIAPINE FUMARATE 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)
30 TABLETS   67877024801 68
PDPs
397
MAPDs
QUETIAPINE FUMARATE 50 MG TABLET [Seroquel]
(Quetiapine Fumarate)
100.000 EA   16729014601 68
PDPs
397
MAPDs
REVLIMID 10 MG CAPSULE
(Lenalidomide)
28.000 EA   59572041028 68
PDPs
397
MAPDs
REVLIMID 15MG CAPSULE 21 BOT
(Lenalidomide)
21 BOT 59572041521 68
PDPs
397
MAPDs
REVLIMID 2.5 MG CAPSULE
(Lenalidomide)
28.000 EA   59572040228 68
PDPs
397
MAPDs
REVLIMID 20 MG CAPSULE
(Lenalidomide)
21.000 EA   59572042021 68
PDPs
397
MAPDs
REVLIMID 25 MG CAPSULE
(Lenalidomide)
21.000 EA   59572042521 68
PDPs
397
MAPDs
REVLIMID 5 MG CAPSULE
(Lenalidomide)
28.000 EA   59572040528 68
PDPs
397
MAPDs
REYATAZ 150MG CAPSULE
(Atazanavir Sulfate)
100 BOT 00003362412 6
PDPs
15
MAPDs
RISEDRONATE SODIUM 150 MG TABLET [Actonel]
(Risedronate Sodium)
1.000 EA   60505309702 29
PDPs
339
MAPDs
RISEDRONATE SODIUM 30 MG TABLET [Actonel]
(Risedronate Sodium)
30 EA   00093310056 23
PDPs
297
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
4 TABLETS   33342010937 27
PDPs
315
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
4 tablets   33342010950 27
PDPs
315
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)
4.000 EA   60505316500 27
PDPs
338
MAPDs
RISEDRONATE SODIUM 5 MG TABLET [Actonel]
(Risedronate Sodium)
30 tablets   33342010707 23
PDPs
323
MAPDs
ROSUVASTATIN CALCIUM 10 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 EA   31722088390 68
PDPs
397
MAPDs
ROSUVASTATIN CALCIUM 20 MG TABLET [Crestor]
(Rosuvastatin Calcium)
30 tablets   31722088490 68
PDPs
397
MAPDs
ROSUVASTATIN CALCIUM 40 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 tablets   31722088530 68
PDPs
397
MAPDs
ROSUVASTATIN CALCIUM 5 MG TABLET [Crestor]
(Rosuvastatin Calcium)
90 EA   31722088290 68
PDPs
397
MAPDs
SENSIPAR 30MG TABLET
(Cinacalcet HCl)
30 BOT 55513007330 4
PDPs
14
MAPDs
SEROQUEL 100MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027110 3
PDPs
8
MAPDs
SEROQUEL 200MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027210 3
PDPs
8
MAPDs
SEROQUEL 25MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027510 3
PDPs
8
MAPDs
SEROQUEL 300MG TABLET
(Quetiapine Fumarate)
60 BOT 00310027460 3
PDPs
8
MAPDs
SEROQUEL 400MG TABLET
(Quetiapine Fumarate)
100 BOT 00310027910 3
PDPs
8
MAPDs
SEROQUEL 50MG TABLET (100 CT)
(Quetiapine Fumarate)
100 BOT 00310027810 3
PDPs
8
MAPDs
SEROQUEL XR 150 MG TABLET
(Quetiapine Fumarate)
60.000 EA   00310028160 3
PDPs
9
MAPDs
SEROQUEL XR 200 MG TABLET
(Quetiapine Fumarate)
60.000 EA   00310028260 3
PDPs
9
MAPDs
SEROQUEL XR 300MG TABLET 60X300MG BOT
(Quetiapine Fumarate)
60 X 300 MG BOT 00310028360 3
PDPs
9
MAPDs
SEROQUEL XR 400 MG TABLET
(Quetiapine Fumarate)
60.000 EA   00310028460 3
PDPs
9
MAPDs
SEROQUEL XR 50 MG TABLET
(Quetiapine Fumarate)
60.000 EA   00310028060 3
PDPs
9
MAPDs
SIMVASTATIN 10 MG TABLET
(Simvastatin)
1000.000 EA   16729000417 68
PDPs
397
MAPDs
SIMVASTATIN 20 MG TABLET
(Simvastatin)
1000.000 EA   16729000517 68
PDPs
397
MAPDs
SIMVASTATIN 40 MG TABLET
(Simvastatin)
1000.000 EA   16729000617 68
PDPs
397
MAPDs
SIMVASTATIN 80 MG TABLET
(Simvastatin)
90 EA   68180046509 68
PDPs
390
MAPDs
SPIRIVA 18 MCG CP-HANDIHALER
(Tiotropium Bromide Monohydrate)
30.000 EA   00597007541 40
PDPs
254
MAPDs
SPIRIVA RESPIMAT INHAL SPRAY
(Tiotropium Bromide Monohydrate)
4 GM   00597010061 40
PDPs
254
MAPDs
STRATTERA 40MG CAPSULE
(Atomoxetine HCl)
30 BOT 00002322930 4
PDPs
9
MAPDs
SUSTIVA 600MG TABLET
(Efavirenz)
30 BOT 00056051030 3
PDPs
8
MAPDs
TARCEVA 150MG TABLET
(Erlotinib)
30 BOT 50242006401 4
PDPs
18
MAPDs
TOBRADEX SUSPENSION OPHTHALMIC 0.1%/0.3% 5ML BOT
(Tobramycin Sulfate)
5 ML BOT 00065064705 3
PDPs
11
MAPDs
TRILEPTAL 300MG TABLET
(Oxcarbazepine)
100 BOT 00078033705 3
PDPs
9
MAPDs
TRUVADA 200/300MG TABLET
(Emtricitabine-Tenofovir Disoproxil Fumarate)
    61958070101 36
PDPs
134
MAPDs
VALCYTE 450MG TABLET
(Valganciclovir HCl)
60 TABLETS BOT 00004003822 3
PDPs
9
MAPDs
VALSARTAN 160 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
30 TABLETS   33342006410 66
PDPs
396
MAPDs
VALSARTAN 320 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
30 tablets   65862057390 66
PDPs
396
MAPDs
VALSARTAN 40 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
30 tablets   65862057030 66
PDPs
396
MAPDs
VALSARTAN 80 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)
30 tablets   65862057190 66
PDPs
396
MAPDs
VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
30 TABLETS   65862054890 65
PDPs
395
MAPDs
VALSARTAN-HCTZ 160-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
90.000 EA   65862054990 65
PDPs
395
MAPDs
VALSARTAN-HCTZ 320-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
30 TABLETS   65862055090 65
PDPs
395
MAPDs
VALSARTAN-HCTZ 320-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
30 TABLETS   65862055190 65
PDPs
395
MAPDs
VALSARTAN-HCTZ 80-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)
30 tablets   33342007410 65
PDPs
395
MAPDs
VIGAMOX 0.5% EYE DROPS
(Moxifloxacin HCl Ophth)
3 ML BOTPL 00065401303 3
PDPs
8
MAPDs
VIREAD 300MG TABLET
(Tenofovir Disoproxil Fumarate)
    61958040101 3
PDPs
10
MAPDs
VYVANSE 30MG CAPSULE
(Lisdexamfetamine Dimesylate)
100 BOT 59417010310 15
PDPs
96
MAPDs
WELCHOL 625MG TABLET
(Colesevelam HCl)
180 BOTPL 65597070118 15
PDPs
23
MAPDs
XALATAN EYE DROPS 125MCG 2.5ML BOTPL
(Latanoprost Ophth)
2.5 ML BOTPL 00013830304 0
PDPs
1
MAPDs
YASMIN 28 3-0.03MG TABLET
(Drospirenone-Ethinyl Estradiol)
21 YELLOW + 7 WHITE X 3 BOX 50419040203 3
PDPs
35
MAPDs
YAZ 3-0.02MG TABLET
(Drospirenone-Ethinyl Estradiol)
24 X 3 BOX 50419040503 4
PDPs
22
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2021)


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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.