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AARP MedicareRx Preferred (PDP) (S5820-014-0)
Tier 1 (1691)
Tier 2 (794)
Tier 3 (2052)
Tier 4 (379)

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2010 Medicare Part D Plan Formulary Information
AARP MedicareRx Preferred (PDP) (S5820-014-0)
Benefit Details  
The AARP MedicareRx Preferred (PDP) (S5820-014-0)
Formulary Drugs Starting with the Letter R

in CMS PDP Region 15 which includes: IN KY
Drugs Starting with Letter R

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
RABIES VACCINE RABAVERT INJECTION 2.5UNT/ML 1 DOSE VIAL   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RAMIPRIL 1.25MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RAMIPRIL 10MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RAMIPRIL 2.5MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RAMIPRIL 5MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RANEXA 1000MG TABLET SR 12HR   2 Tier 2 Generic Preferred Brand $42.00$111.00S
RANEXA 500MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00S
RANICLOR 250MG TABLET CHEWABLE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RANICLOR 375MG TABLET CHEWABLE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RANITIDINE 150MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RANITIDINE HCL 15MG/ML SYRUP   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RANITIDINE HCL 25MG/ML VIAL   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RANITIDINE HCL 300MG CAPSULE (30 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RANITIDINE TABLET 300MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RANITIDINE TABLET USP 150MG (500 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RAPAFLO CAPSULES 4MG 30 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00S Q:31
/31Days
RAPAFLO CAPSULES 8MG 90 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00S Q:31
/31Days
RAPAMUNE 1MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RAPAMUNE 1MG/ML ORAL TUBEX   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RAPAMUNE 2MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RAPIFLUX FLUOXETINE 20MG ORAL TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RAZADYNE 12MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RAZADYNE 4MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RAZADYNE 8MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RAZADYNE ER 16MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:31
/31Days
RAZADYNE ER 24MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:31
/31Days
RAZADYNE ER 8MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:31
/31Days
RAZADYNE SOL 4MG/ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REBETOL 200MG CAPSULE 84 EA   4 Tier 4 Specialty 33%33%P
REBETOL 40MG/ML SOLUTION   4 Tier 4 Specialty 33%33%P
REBIF 22MCG/0.5ML SYRINGE   4 Tier 4 Specialty 33%33%P
REBIF 44MCG/0.5ML SYRINGE   4 Tier 4 Specialty 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL   4 Tier 4 Specialty 33%33%P
RECLIPSEN 0.15-0.03 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RECOMBIVAX HB 40MCG/ML VIAL   2 Tier 2 Generic Preferred Brand $42.00$111.00P
REGLAN 10MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REGLAN 5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REGLAN 5MG/ML VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REGONOL AMP 10MG 5ML   2 Tier 2 Generic Preferred Brand $42.00$111.00None
REGRANEX 0.01% GEL   4 Tier 4 Specialty 33%33%P Q:30
/31Days
RELENZA 5MG DISKHALER   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:62
/31Days
RELION 70/30 INJ 100/ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RELION N INJ 100/ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RELION R INJ 100/ML   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RELISTOR SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RELPAX 20MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00S Q:6
/30Days
RELPAX 40MG TABLET 6X2 BLPK   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00S Q:6
/30Days
REMERON 15MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMERON 30MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMERON 45MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMERON SLTABLET 45MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REMICADE 100MG VIAL   4 Tier 4 Specialty 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REMODULIN 10MG/ML VIAL   4 Tier 4 Specialty 33%33%P
REMODULIN 1MG/ML VIAL   4 Tier 4 Specialty 33%33%P
REMODULIN 2.5MG/ML VIAL   4 Tier 4 Specialty 33%33%P
REMODULIN 5MG/ML VIAL   4 Tier 4 Specialty 33%33%P
RENAMIN 6.5% IV SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RENVELA 800MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00None
REPREXAIN 5-200 MG TABLET 100 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REPREXAIN TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REPREXAIN TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 0.25MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 0.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REQUIP 1MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 2MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 3MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 4MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP 5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP XL ROPINIROLE HCL 2MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP XL ROPINIROLE HCL 4MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP XL ROPINIROLE HCL 8MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REQUIP XL TABLET 12 MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RESCRIPTOR 100MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RESCRIPTOR 200MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RESERPINE 0.1MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RESERPINE 0.25MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RETIN-A 0.01% GEL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A 0.025% CREAM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A 0.025% GEL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A 0.05% CREAM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A 0.1% CREAM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A MICRO 0.04% GEL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETIN-A MICRO 0.1% GEL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P
RETROVIR 100MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RETROVIR 10MGML SYRUP   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RETROVIR 300MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RETROVIR IV INFUSION VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REVATIO 20MG TABLET   4 Tier 4 Specialty 33%33%P
REVIA 50MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
REVLIMID 10MG CAPSULE (100 CT)   4 Tier 4 Specialty 33%33%P
REVLIMID 15MG CAPSULE 21 BOT   4 Tier 4 Specialty 33%33%P
REVLIMID 25MG CAPSULE (100 CT)   4 Tier 4 Specialty 33%33%P
REVLIMID 5MG CAPSULE   4 Tier 4 Specialty 33%33%P
REYATAZ 100MG CAPSULE   4 Tier 4 Specialty 33%33%None
REYATAZ 150MG CAPSULE   4 Tier 4 Specialty 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REYATAZ 200MG CAPSULE   4 Tier 4 Specialty 33%33%None
REYATAZ 300MG CAPSULE   4 Tier 4 Specialty 33%33%None
RHEUMATREX 2.5MG TABLET DOSE PACK   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RHINOCORT AQUA NASAL SPRAY 32 MCG/SPRAY   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:17
/30Days
RIBAPAK 400-400MG TABLET DOSE PACK   4 Tier 4 Specialty 33%33%P
RIBAPAK 600-400MG TABLET DOSE PACK   4 Tier 4 Specialty 33%33%P
RIBAPAK 600-600MG TABLET DOSE PACK   4 Tier 4 Specialty 33%33%P
RIBASPHERE 200MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBASPHERE 400MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBASPHERE 600MG TABLET   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBASPHERE CAPSULES 200MG 42 BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RIBAVIRIN 200MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBAVIRIN 200MG TABLET 168 BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBAVIRIN TABLETS 400MG 56 TABS BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIBAVIRIN TABLETS 600MG 56 TABS BOT   2 Tier 2 Generic Preferred Brand $42.00$111.00P
RIDAURA 3MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RIFADIN 150MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RIFADIN 300MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RIFADIN IV 600MG VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RIFAMATE CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RIFAMPIN 150MG CAPSULE (30 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RIFAMPIN 300MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RIFAMPIN 600MG VIAL   4 Tier 4 Specialty 33%33%None
RIFATER TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RILUTEK 50MG TABLET   4 Tier 4 Specialty 33%33%None
RIMANTADINE 100MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RINGERS INJECTION 1000ML BAG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RINGERS IRRIGATION 860-30 12X1000ML BAG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RIOMET 500MG/5ML SOLUTION ORAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 0.25MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 0.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 1MG M-TAB   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 1MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERDAL 1MG/ML SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 2MG M-TAB   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 2MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 3MG M-TAB   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 3MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 4MG M-TAB   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL 4MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERDAL CONSTA 25MG SYR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:4
/28Days
RISPERDAL CONSTA 37.5MG SYR   4 Tier 4 Specialty 33%33%Q:4
/28Days
RISPERDAL CONSTA 50MG SYR   4 Tier 4 Specialty 33%33%Q:4
/28Days
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:4
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERDAL M TABLET 0.5MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RISPERIDONE ORAL SOLUTION 1MG 30 ML BOTDR   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RISPERIDONE TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RISPERIDONE TABLET 1 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RISPERIDONE TABLET 2 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RISPERIDONE TABLET 3 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RISPERIDONE TABLET 4 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RISPERIDONE TABLETS 3MG 4 IN 1 BLPK   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RISPERIDONE TABLETS 4MG 4 IN 1 BLPK   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RISPERIDONE TABLETS ORALLY DISINTEGRATING 0.5MG 30 BLPK   2 Tier 2 Generic Preferred Brand $42.00$111.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERIDONE TABLETS ORALLY DISINTEGRATING 2MG 30 BLPK   2 Tier 2 Generic Preferred Brand $42.00$111.00None
RISPERIODONE TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
RITALIN 10MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:186
/31Days
RITALIN 20MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:93
/31Days
RITALIN 5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:372
/31Days
RITALIN LA 10MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:62
/31Days
RITALIN LA 20MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:93
/31Days
RITALIN LA 30MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:62
/31Days
RITALIN LA 40MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:31
/31Days
RITALIN-SR 20MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:93
/31Days
RITUXAN 10MG/ML VIAL   4 Tier 4 Specialty 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROBAXIN 100MG/ML VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROBAXIN 500MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROBAXIN-750 TABLET 750MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROBINUL 0.2MG/ML VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROBINUL 1MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROBINUL FORTE 2MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROCALTROL 1MCG/ML ORAL TUBEX   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROCALTROL CAPS 0.25MCG 100 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROCALTROL CAPS 0.5MCG 100 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROCEPHIN 1GM VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROCEPHIN 2GM/DEXTROSE 2.4%   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROCEPHIN/DEX INJ 1GM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROMYCIN 5MG/G OINTMENT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET 1 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET 2 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET 3 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET 4 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HCL TABLET 5 MG   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROPINIROLE HYDROCLORIDE TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROTATEQ VACCINE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ROWASA RECTAL SUSPENSION ENEMA 4GM/60ML 7 X 60ML BOTUD   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROXICET 5-325/5ML SOLUTION ORAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROXICET 5/325 TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROXICET 5/500 CAPLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ROXICODONE 15MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROXICODONE 30MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
ROZEREM 8MG TABLET (100 CT)   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00Q:31
/31Days
RYTHMOL 150MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RYTHMOL 225MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RYTHMOL 300MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RYTHMOL SR 225MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RYTHMOL SR 425MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES ER 325MG 60 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00None
RYZOLT EXTENDED RELEASE TABLETS 100MG 30 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P Q:31
/31Days
RYZOLT EXTENDED RELEASE TABLETS 200MG 30 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P Q:31
/31Days
RYZOLT EXTENDED RELEASE TABLETS 300MG 30 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $71.00$198.00P Q:31
/31Days

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D AARP MedicareRx Preferred (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2830) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2010 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • 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.