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2022 Medicare Part D Formulary Search By Drug Letter
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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Top Medicare Drugs (Short List) in Alphabetical Order

Drug Name
 Packaging NDC On This Nbr of 2022 Formularies
PDPs MAPDs
ABILIFY 10MG TABLET
(Aripiprazole)		 30 BOT 59148000813 2
PDPs		 2
MAPDs
ABILIFY 15MG TABLET
(Aripiprazole)		 30 BOT 59148000913 2
PDPs		 2
MAPDs
ABILIFY 20MG TABLET
(Aripiprazole)		 30 BOT 59148001013 2
PDPs		 2
MAPDs
ABILIFY 2MG TABLET
(Aripiprazole)		 30 BOX 59148000613 2
PDPs		 2
MAPDs
ABILIFY 30MG TABLET
(Aripiprazole)		 30 BOT 59148001113 2
PDPs		 2
MAPDs
ABILIFY 5 MG TABLET
(Aripiprazole)		 30 tablets BOT 59148000713 2
PDPs		 2
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
ACTOS 15 MG TABLET
(Pioglitazone HCL)		     64764015104 2
PDPs		 3
MAPDs
ACTOS 30 MG TABLET
(Pioglitazone HCL)		     64764030114 2
PDPs		 3
MAPDs
ACTOS 45 MG TABLET
(Pioglitazone HCL)		     64764045124 2
PDPs		 3
MAPDs
ADVAIR DISKUS MIS 100/50
(Fluticasone-Salmeterol)		 60 DOSE INHL 00173069500 52
PDPs		 303
MAPDs
ADVAIR DISKUS MIS 250/50
(Fluticasone-Salmeterol)		 60 DOSE BLPK 00173069600 52
PDPs		 303
MAPDs
ADVAIR DISKUS MIS 500/50
(Fluticasone-Salmeterol)		 60 BLPK 00173069700 52
PDPs		 303
MAPDs
ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify]
(Aripiprazole)		 60 MLS   54838057059 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 10 MG TABLET [Abilify]
(Aripiprazole)		 30 tablets   13668021830 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 15 MG TABLET [Abilify]
(Aripiprazole)		 30 TABLETS   13668021930 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 2 MG TABLET [Abilify]
(Aripiprazole)		 30 tablets   13668021630 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 20 MG TABLET [Abilify]
(Aripiprazole)		 30 tablets   13668022030 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 30 MG TABLET [Abilify]
(Aripiprazole)		 30 TABLETS   13668022130 63
PDPs		 404
MAPDs
ARIPIPRAZOLE 5 MG TABLET [Abilify]
(Aripiprazole)		 30 tablets   13668021730 63
PDPs		 404
MAPDs
ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt]
(Aripiprazole)		 30 units   62332010330 63
PDPs		 404
MAPDs
ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt]
(Aripiprazole)		 units   62332010430 63
PDPs		 401
MAPDs
ATORVASTATIN 10 MG TABLET [Lipitor]
(Atorvastatin Calcium)		 1000.000 EA   60505257808 63
PDPs		 404
MAPDs
ATORVASTATIN 20 MG TABLET [Lipitor]
(Atorvastatin Calcium)		 1000.000 EA   60505257908 63
PDPs		 404
MAPDs
ATORVASTATIN 40 MG TABLET [Lipitor]
(Atorvastatin Calcium)		 1000 EA   60505258008 63
PDPs		 404
MAPDs
ATORVASTATIN 80 MG TABLET [Lipitor]
(Atorvastatin Calcium)		 30 tablets   60505267108 63
PDPs		 404
MAPDs
CLOPIDOGREL 75 MG TABLET [Plavix]
(Clopidogrel)		 30 TABLETS   16729021816 63
PDPs		 404
MAPDs
CRESTOR 10 MG TABLET
(Rosuvastatin Calcium)		 30 TABLETS   00310757090 2
PDPs		 1
MAPDs
CRESTOR 20 MG TABLET
(Rosuvastatin Calcium)		 90 TABLETS   00310758090 2
PDPs		 1
MAPDs
CRESTOR 40 MG TABLET
(Rosuvastatin Calcium)		 90 TABLETS   00310759030 2
PDPs		 1
MAPDs
CRESTOR 5 MG TABLET
(Rosuvastatin Calcium)		 90 TABLETS   00310756090 2
PDPs		 1
MAPDs
CYMBALTA 20MG CAPSULE
(Duloxetine HCl Enteric Coated Pellets)		 60 BOT 00002323560 2
PDPs		 1
MAPDs
CYMBALTA 60 MG CAPSULE
(Duloxetine HCl Enteric Coated Pellets)		 30.000 EA   00002327030 2
PDPs		 1
MAPDs
CYMBALTA CAPSULES DELAYED RELEASE 30MG (30 CT)
(Duloxetine HCl Enteric Coated Pellets)		 30 BOT 00002324030 2
PDPs		 1
MAPDs
DIOVAN 160MG TABLET
(Valsartan)		 90 BOT 00078035934 2
PDPs		 3
MAPDs
DIOVAN 320MG TABLET
(Valsartan)		 90 BOT 00078036034 2
PDPs		 3
MAPDs
DIOVAN 40MG TABLET
(Valsartan)		 30 BOT 00078042315 2
PDPs		 3
MAPDs
DIOVAN 80MG TABLET
(Valsartan)		 90 BOX 00078035834 2
PDPs		 3
MAPDs
DIOVAN HCT 160/12.5MG TABLET
(Valsartan)		 90 BOT 00078031534 2
PDPs		 3
MAPDs
DIOVAN HCT 160/25MG TABLET
(Valsartan)		 90 BOT 00078038334 2
PDPs		 3
MAPDs
DIOVAN HCT 320/12.5MG TABLET
(Valsartan)		 90 BOT 00078047134 2
PDPs		 3
MAPDs
DIOVAN HCT 320/25MG TABLET
(Valsartan)		 90 BOT 00078047234 2
PDPs		 3
MAPDs
DIOVAN HCT 80/12.5MG TABLET
(Valsartan)		 90 BOT 00078031434 2
PDPs		 3
MAPDs
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta]
(Duloxetine)		 30 units   57237001760 63
PDPs		 404
MAPDs
DULOXETINE HCL DR 40 MG CAPSULE [Irenka]
(Duloxetine)		 30 units   68180029706 12
PDPs		 164
MAPDs
ESCITALOPRAM 10 MG TABLET [Lexapro]
(Escitalopram)		 30 TABLETS   43547028111 63
PDPs		 404
MAPDs
ESCITALOPRAM 20 MG TABLET [Lexapro]
(Escitalopram)		 30 TABLETS   43547028211 63
PDPs		 404
MAPDs
ESCITALOPRAM 5 MG TABLET [Lexapro]
(Escitalopram)		 30 TABLETS   43547028010 63
PDPs		 404
MAPDs
ESCITALOPRAM OXALATE 5 MG/5 ML SOLUTION [Lexapro]
(Escitalopram)		 300 MLS   54838055170 63
PDPs		 404
MAPDs
ESOMEPRAZOLE DR 10 MG SUSPDR PACKET [Nexium]
(Esomeprazole)		 30 UNITS   69097052734 9
PDPs		 74
MAPDs
ESOMEPRAZOLE DR 20 MG SUSPDR PACKET [Nexium]
(Esomeprazole)		 30 UNITS   69097052834 9
PDPs		 74
MAPDs
ESOMEPRAZOLE DR 40 MG SUSPDR PACKET [Nexium]
(Esomeprazole)		 30 UNITS   69097052934 9
PDPs		 74
MAPDs
ESOMEPRAZOLE MAG DR 40 MG CAPSULE DR [Nexium]
()		 30 UNITS   65862078430 45
PDPs		 380
MAPDs
FUROSEMIDE 10 MG/ML SOLUTION
(Furosemide)		 60.000 ML   00054329446 59
PDPs		 398
MAPDs
FUROSEMIDE 100 MG/10 ML VIAL
(Furosemide)		 3 MLS   36000028425 63
PDPs		 403
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 63
PDPs		 388
MAPDs
FUROSEMIDE 20 MG TABLET [Lasix]
(Furosemide)		 90 TABLETS   00904717761 63
PDPs		 404
MAPDs
FUROSEMIDE 40 MG TABLET [Lasix]
(Furosemide)		 30 TABLETS   69315011710 63
PDPs		 404
MAPDs
FUROSEMIDE 40MG/5ML TUBEX
(Furosemide)		 500 ML BOT 00054329863 39
PDPs		 361
MAPDs
FUROSEMIDE 80 MG TABLET [Lasix]
(Furosemide)		 30 TABLETS   43547040350 63
PDPs		 404
MAPDs
HYDROCODON-ACETAMINOPH 7.5-325
(Hydrocodone-Acetaminophen)		 100.000 EA   00406012401 63
PDPs		 404
MAPDs
HYDROCODON-ACETAMINOPHEN 5-325
(Hydrocodone-Acetaminophen)		 100.000 EA   00406012301 63
PDPs		 404
MAPDs
HYDROCODONE-ACETAMN 7.5-325/15 SOLUTION [Hycet]
(Hydrocodone Bitartrate, Acetaminophen)		 473 MLS   66689002316 59
PDPs		 376
MAPDs
JANUVIA 25MG TABLET
(Sitagliptin Phosphate)		 30 BOT 00006022131 59
PDPs		 339
MAPDs
JANUVIA 50 MG TABLET
(Sitagliptin Phosphate)		 30.000 EA   00006011231 59
PDPs		 339
MAPDs
JANUVIA TABLET 100MG (30 CT)
(Sitagliptin Phosphate)		 30 BOT 00006027731 59
PDPs		 339
MAPDs
LANTUS 100U/ML VIAL
(Insulin Glargine)		 10 ML VIAL 00088222033 53
PDPs		 318
MAPDs
LANTUS SOLOSTAR INJECTION
(Insulin Glargine)		 3 ML X 5 CRTG CRTN 00088221905 53
PDPs		 318
MAPDs
LENALIDOMIDE 10 MG CAPSULE [Revlimid]
()		 28 CAPSULES   00480124328 61
PDPs		 392
MAPDs
LENALIDOMIDE 15 MG CAPSULE [Revlimid]
()		 21 CAPSULES   00480124421 61
PDPs		 392
MAPDs
LENALIDOMIDE 25 MG CAPSULE [Revlimid]
()		 21 CAPSULES   00480124621 61
PDPs		 392
MAPDs
LENALIDOMIDE 5 MG CAPSULE [Revlimid]
()		 21 CAPSULES   00480124228 61
PDPs		 392
MAPDs
LEVOTHYROXINE 100 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378180910 63
PDPs		 404
MAPDs
LEVOTHYROXINE 112 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378181110 63
PDPs		 404
MAPDs
LEVOTHYROXINE 137 MCG TABLET
(Levothyroxine Sodium)		 90 EA   00378182377 63
PDPs		 404
MAPDs
LEVOTHYROXINE 150 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378181510 63
PDPs		 404
MAPDs
LEVOTHYROXINE 175 MCG TABLET
(Levothyroxine Sodium)		 1000 EA   00378181710 63
PDPs		 404
MAPDs
LEVOTHYROXINE 25 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378180010 63
PDPs		 404
MAPDs
LEVOTHYROXINE 50 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378180310 63
PDPs		 404
MAPDs
LEVOTHYROXINE 75 MCG TABLET
(Levothyroxine Sodium)		 1000 EA   00378180510 63
PDPs		 404
MAPDs
LEVOTHYROXINE 88 MCG TABLET
(Levothyroxine Sodium)		 1000.000 EA   00378180710 63
PDPs		 404
MAPDs
LEXAPRO 10MG TABLET
(Escitalopram Oxalate)		 10 BOT 00456201001 2
PDPs		 3
MAPDs
LEXAPRO 20MG TABLET
(Escitalopram Oxalate)		 100 TABLETS BOT 00456202001 2
PDPs		 3
MAPDs
LEXAPRO 5MG TABLET
(Escitalopram Oxalate)		 100 BOT 00456200501 2
PDPs		 3
MAPDs
LIPITOR 10MG TABLET
(Atorvastatin Calcium)		 90 BOT 00071015523 2
PDPs		 1
MAPDs
LIPITOR 20 MG TABLET
(Atorvastatin Calcium)		     00071015623 2
PDPs		 1
MAPDs
LIPITOR 40 MG TABLET
(Atorvastatin Calcium)		 90.000 EA   00071015723 2
PDPs		 1
MAPDs
LIPITOR 80 MG TABLET
(Atorvastatin Calcium)		 90.000 EA   00071015823 2
PDPs		 1
MAPDs
LISINOPRIL 10 MG TABLET
(Lisinopril)		 1000 EA   68180098003 63
PDPs		 404
MAPDs
LISINOPRIL 2.5 MG TABLET
(Lisinopril)		 500.000 EA   68180051202 63
PDPs		 404
MAPDs
LISINOPRIL 20 MG TABLET
(Lisinopril)		 1000 EA   68180098103 63
PDPs		 404
MAPDs
LISINOPRIL 30 MG TABLET
(Lisinopril)		 100 EA   68180098201 63
PDPs		 404
MAPDs
LISINOPRIL 5 MG TABLET
(Lisinopril)		 1000.000 EA   68180051303 63
PDPs		 404
MAPDs
LISINOPRIL-HCTZ 10-12.5 MG TABLET
(Lisinopril)		 500.000 EA   68180051802 63
PDPs		 404
MAPDs
LISINOPRIL-HCTZ 20-12.5 MG TABLET
(Lisinopril)		 500.000 EA   68180051902 63
PDPs		 404
MAPDs
LISINOPRIL-HCTZ 20-25 MG TABLET
(Lisinopril)		 500.000 EA   68180052002 63
PDPs		 404
MAPDs
MEMANTINE HCL 10 MG TABLET [Namenda]
(Memantine HCl)		 60 tablets   29300017216 63
PDPs		 404
MAPDs
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda]
(Memantine HCl)		     00527194313 59
PDPs		 379
MAPDs
MEMANTINE HCL 5 MG TABLET [Namenda]
(Memantine HCl)		 60 tablets   29300017116 63
PDPs		 404
MAPDs
METFORMIN HCL 1,000 MG TABLET
(Metformin HCl)		 1000.000 EA   23155010410 63
PDPs		 404
MAPDs
METFORMIN HCL 500 MG TABLET
(Metformin HCl)		 1000.000 EA   23155010210 63
PDPs		 404
MAPDs
METFORMIN HCL 625 MG TABLET
(Metformin HCl)		 60 TABLETS   72336006430 0
PDPs		 5
MAPDs
METOPROLOL TARTRATE 25 MG TABLET
(Metoprolol Tartrate)		 500.000 EA   00378001805 63
PDPs		 404
MAPDs
METOPROLOL TARTRATE 37.5 MG TABLET
(Metoprolol Tartrate)		 60 TABLETS   52817035810 24
PDPs		 203
MAPDs
METOPROLOL TARTRATE 75 MG TABLET
(Metoprolol Tartrate)		 60 TABLETS   52817035910 24
PDPs		 203
MAPDs
NAMENDA 10MG TABLET
(Memantine HCl)		 60 BOT 00456321060 2
PDPs		 1
MAPDs
NAMENDA 5-10MG TITRATION PK
(Memantine HCl)		 49 COUNT 00456320014 4
PDPs		 4
MAPDs
NAMENDA 5MG TABLET
(Memantine HCl)		 60 BOT 00456320560 2
PDPs		 1
MAPDs
NAMENDA XR 14 MG CAPSULE
(Memantine HCl)		 30 EA   00456341433 0
PDPs		 1
MAPDs
NAMENDA XR 21 MG CAPSULE
(Memantine HCl)		     00456342133 0
PDPs		 1
MAPDs
NAMENDA XR 28 MG CAPSULE
(Memantine HCl)		 30.000 EA   00456342833 0
PDPs		 1
MAPDs
NAMENDA XR 7 MG CAPSULE
(Memantine HCl)		     00456340733 0
PDPs		 1
MAPDs
NEXIUM 10mg/1 30 GRANULE, DELAYED RELEASE per CARTON
(Esomeprazole Magnesium)		 30 GRANULE, DELAYED RELEA   00186401001 2
PDPs		 10
MAPDs
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)		 20 MG PKT X 30 PKT 00186402001 2
PDPs		 21
MAPDs
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET
(Esomeprazole Magnesium)		 40 MG PKT X 30 PKT 00186404001 2
PDPs		 21
MAPDs
NEXIUM DR 2.5 MG PACKET
(Esomeprazole Magnesium)		     00186402501 8
PDPs		 30
MAPDs
NEXIUM DR 20 MG CAPSULE
(Esomeprazole Magnesium)		 30.000 EA   00186502031 2
PDPs		 1
MAPDs
NEXIUM DR 40 MG CAPSULE
(Esomeprazole Magnesium)		 30.000 EA   00186504031 2
PDPs		 1
MAPDs
NEXIUM DR 5 MG PACKET
(Esomeprazole Magnesium)		     00186405001 8
PDPs		 30
MAPDs
PIOGLITAZONE HCL 15 MG TABLET [Actos]
(Pioglitazone HCL)		 30 TABLETS   00093727198 63
PDPs		 404
MAPDs
PIOGLITAZONE HCL 30 MG TABLET [Actos]
(Pioglitazone HCL)		 30 TABLETS   00093727298 63
PDPs		 404
MAPDs
PIOGLITAZONE HCL 45 MG TABLET [Actos]
(Pioglitazone HCL)		 90 TABLETS   00093727398 63
PDPs		 404
MAPDs
PLAVIX 75 MG TABLET
(Clopidogrel Bisulfate)		 90 TABLETS   00024117190 2
PDPs		 1
MAPDs
QUETIAPINE ER 150 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)		 30 tablets   16729010912 46
PDPs		 356
MAPDs
QUETIAPINE ER 200 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)		 30 tablets   16729009512 46
PDPs		 356
MAPDs
QUETIAPINE ER 300 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)		 30 tablets   16729009612 46
PDPs		 356
MAPDs
QUETIAPINE ER 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 60.000 EA   16729009712 46
PDPs		 356
MAPDs
QUETIAPINE ER 50 MG TABLET ER 24H [Seroquel XR]
(Quetiapine Fumarate)		 30 TABLETS   16729013212 46
PDPs		 356
MAPDs
QUETIAPINE FUMARATE 100 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877025001 63
PDPs		 404
MAPDs
QUETIAPINE FUMARATE 200 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877024601 63
PDPs		 404
MAPDs
QUETIAPINE FUMARATE 25 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877024201 63
PDPs		 404
MAPDs
QUETIAPINE FUMARATE 300 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877024760 63
PDPs		 404
MAPDs
QUETIAPINE FUMARATE 400 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877024801 63
PDPs		 404
MAPDs
QUETIAPINE FUMARATE 50 MG TABLET [Seroquel]
(Quetiapine Fumarate)		 30 TABLETS   67877024901 63
PDPs		 404
MAPDs
REVLIMID 10 MG CAPSULE
(Lenalidomide)		 28.000 EA   59572041028 59
PDPs		 306
MAPDs
REVLIMID 15MG CAPSULE 21 BOT
(Lenalidomide)		 21 BOT 59572041521 59
PDPs		 306
MAPDs
REVLIMID 2.5 MG CAPSULE
(Lenalidomide)		 28.000 EA   59572040228 63
PDPs		 404
MAPDs
REVLIMID 20 MG CAPSULE
(Lenalidomide)		 21.000 EA   59572042021 63
PDPs		 404
MAPDs
REVLIMID 25 MG CAPSULE
(Lenalidomide)		 21.000 EA   59572042521 59
PDPs		 306
MAPDs
REVLIMID 5 MG CAPSULE
(Lenalidomide)		 28.000 EA   59572040528 59
PDPs		 306
MAPDs
RISEDRONATE SODIUM 150 MG TABLET [Actonel]
(Risedronate Sodium)		 3 TABLETS   00093777179 24
PDPs		 352
MAPDs
RISEDRONATE SODIUM 30 MG TABLET [Actonel]
(Risedronate Sodium)		 30 EA   00093310056 20
PDPs		 307
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)		 4 TABLETS   33342010937 24
PDPs		 337
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)		 4 tablets   33342010950 24
PDPs		 337
MAPDs
RISEDRONATE SODIUM 35 MG TABLET [Actonel]
(Risedronate Sodium)		 4.000 EA   60505316500 24
PDPs		 351
MAPDs
RISEDRONATE SODIUM 5 MG TABLET [Actonel]
(Risedronate Sodium)		 30 tablets   33342010707 22
PDPs		 337
MAPDs
ROSUVASTATIN CALCIUM 10 MG TABLET [Crestor]
(Rosuvastatin Calcium)		 90 TABLETS   72205000390 63
PDPs		 404
MAPDs
ROSUVASTATIN CALCIUM 20 MG TABLET [Crestor]
(Rosuvastatin Calcium)		 30 TABLETS   72205000490 63
PDPs		 404
MAPDs
ROSUVASTATIN CALCIUM 40 MG TABLET [Crestor]
(Rosuvastatin Calcium)		 90 tablets   31722088530 63
PDPs		 404
MAPDs
ROSUVASTATIN CALCIUM 5 MG TABLET [Crestor]
(Rosuvastatin Calcium)		 90 TABLETS   72205002790 63
PDPs		 404
MAPDs
SEROQUEL 100MG TABLET
(Quetiapine Fumarate)		 100 BOT 00310027110 2
PDPs		 1
MAPDs
SEROQUEL 200MG TABLET
(Quetiapine Fumarate)		 100 BOT 00310027210 2
PDPs		 1
MAPDs
SEROQUEL 25MG TABLET
(Quetiapine Fumarate)		 100 BOT 00310027510 2
PDPs		 1
MAPDs
SEROQUEL 300MG TABLET
(Quetiapine Fumarate)		 60 BOT 00310027460 2
PDPs		 1
MAPDs
SEROQUEL 400MG TABLET
(Quetiapine Fumarate)		 100 BOT 00310027910 2
PDPs		 1
MAPDs
SEROQUEL 50MG TABLET (100 CT)
(Quetiapine Fumarate)		 100 BOT 00310027810 2
PDPs		 1
MAPDs
SEROQUEL XR 150 MG TABLET
(Quetiapine Fumarate)		 60.000 EA   00310028160 2
PDPs		 2
MAPDs
SEROQUEL XR 200 MG TABLET
(Quetiapine Fumarate)		 60.000 EA   00310028260 2
PDPs		 2
MAPDs
SEROQUEL XR 300MG TABLET 60X300MG BOT
(Quetiapine Fumarate)		 60 X 300 MG BOT 00310028360 2
PDPs		 2
MAPDs
SEROQUEL XR 400 MG TABLET
(Quetiapine Fumarate)		 60.000 EA   00310028460 2
PDPs		 2
MAPDs
SEROQUEL XR 50 MG TABLET
(Quetiapine Fumarate)		 60.000 EA   00310028060 2
PDPs		 2
MAPDs
SIMVASTATIN 10 MG TABLET
(Simvastatin)		 1000.000 EA   16729000417 63
PDPs		 404
MAPDs
SIMVASTATIN 20 MG TABLET
(Simvastatin)		 1000.000 EA   16729000517 63
PDPs		 404
MAPDs
SIMVASTATIN 40 MG TABLET
(Simvastatin)		 1000.000 EA   16729000617 63
PDPs		 404
MAPDs
SPIRIVA 18 MCG CP-HANDIHALER
(Tiotropium Bromide Monohydrate)		 30.000 EA   00597007541 41
PDPs		 265
MAPDs
SPIRIVA RESPIMAT INHAL SPRAY
(Tiotropium Bromide Monohydrate)		 4 GM   00597010061 41
PDPs		 267
MAPDs
VALSARTAN 160 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   33342006410 61
PDPs		 403
MAPDs
VALSARTAN 320 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   00378581577 61
PDPs		 403
MAPDs
VALSARTAN 40 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   33342006207 61
PDPs		 403
MAPDs
VALSARTAN 80 MG TABLET [Diovan]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   33342006310 61
PDPs		 403
MAPDs
VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   00378632277 61
PDPs		 402
MAPDs
VALSARTAN-HCTZ 160-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)		 30 TABLETS   00378632377 61
PDPs		 402
MAPDs
VALSARTAN-HCTZ 320-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)		 90 TABLETS   00378632477 61
PDPs		 402
MAPDs
VALSARTAN-HCTZ 320-25 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)		 90 TABLETS   00378632577 61
PDPs		 402
MAPDs
VALSARTAN-HCTZ 80-12.5 MG TABLET [Diovan HCT]
(Valsartan-Hydrochlorothiazide)		 30 tablets   33342007410 61
PDPs		 402
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022)




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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.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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  • 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.
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