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AARP MedicareRx Enhanced (PDP) (S5921-003-0)
Tier 1 (1691)
Tier 2 (794)
Tier 3 (2052)
Tier 4 (379)

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Cick on the first letter of your drug name to browse the formulary:

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M N O P Q R S T U V W X Y Z 0-9 
2010 Medicare Part D Plan Formulary Information
AARP MedicareRx Enhanced (PDP) (S5921-003-0)
Benefit Details  
The AARP MedicareRx Enhanced (PDP) (S5921-003-0)
Formulary Drugs Starting with the Letter I
in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter I

Drug Name		 Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order
IBUPROFEN 100MG/5ML SUSP   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IBUPROFEN TABLET 400MG 1 BLPK   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IBUPROFEN TABLETS 600MG 90 BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IBUPROFEN TABLETS USP 800MG 10 X 10 BOXUD   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IDAMYCIN PFS 1MG/ML VIAL   4 Tier 4 Specialty 33%33%None
IDARUBICIN HCL 1MG/ML VIAL   4 Tier 4 Specialty 33%33%None
IFEX INJECTION 3GM/ML 3GM VIALSD   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IFOSFAMIDE 1GM VIAL   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/   4 Tier 4 Specialty 33%33%None
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/   4 Tier 4 Specialty 33%33%None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
IMDUR 120MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IMDUR 30MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IMDUR 60MG TABLET SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IMIPRAMINE HCL 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IMIPRAMINE HCL 25MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IMIPRAMINE HCL 50MG TABLET (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IMIPRAMINE PAMOATE 100MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IMIPRAMINE PAMOATE 125MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IMIPRAMINE PAMOATE 150MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IMIPRAMINE PAMOATE 75MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IMITREX 100MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:9
/30Days
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
IMITREX 20MG NASAL SPRAY   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:6
/30Days
IMITREX 25MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:9
/30Days
IMITREX 4MG/0.5ML KIT REFILL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:4
/30Days
IMITREX 50MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:9
/30Days
IMITREX 5MG NASAL SPRAY   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:6
/30Days
IMITREX 6MG/0.5ML SYRNG KIT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:4
/30Days
IMITREX 6MG/0.5ML VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00Q:4
/30Days
IMOVAX RABIES VACCINE 2.5UNT/ML   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IMURAN 50MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INCRELEX 40MG/4ML VIAL   4 Tier 4 Specialty 33%33%P
INDAPAMIDE 1.25MG TABLET USP (1000 CT)   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
INDAPAMIDE 2.5MG TABLET USP (1000 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDOCIN SR 75MG CAPSULE SA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INDOMETHACIN 25MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
INDOMETHACIN 50MG CAPSULE   1 Tier 1 Preferred Generic Brand $7.00$4.00None
INDOMETHACIN 75MG CAPSULE SA   1 Tier 1 Preferred Generic Brand $7.00$4.00None
INFANRIX VACCINE VIAL 25-10UNT/.5ML   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
INFERGEN SOLUTION FOR INJECTION 15MCG/0.5ML   4 Tier 4 Specialty 33%33%P
INFUMORPH 10MG/ML AMPUL P/F   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INFUMORPH 25MG/ML AMPUL P/F   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INNOHEP 20000UNIT/ML VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INNOPRAN XL (PROPRANOLOL HCL) 120MG CAPSULE SR 24 HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INNOPRAN XL (PROPRANOLOL HCL) 80MG CAPSULE SR 24 HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INSPRA 25MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INSPRA 50MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INTAL INH AER 800MCG   2 Tier 2 Generic Preferred Brand $42.00$111.00None
INTELENCE 100MG TABLET   4 Tier 4 Specialty 33%33%None
INTRALIPID 20% IV FAT EMUL   1 Tier 1 Preferred Generic Brand $7.00$4.00P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00P
INTRON A 10MMU INJ PEN   4 Tier 4 Specialty 33%33%P
INTRON A 10MMU VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00P
INTRON A 3MMU INJECTION PEN   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00P Q:6
/28Days
INTRON A 5MMU MULTIDOSE PEN   4 Tier 4 Specialty 33%33%P
INTRON A 6MMU/ML VIAL   4 Tier 4 Specialty 33%33%P
INVANZ 1GM VIAL   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00S
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00S
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00S
INVERSINE 2.5MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
INVIRASE 200MG CAPSULE   4 Tier 4 Specialty 33%33%None
INVIRASE 500MG TABLET   4 Tier 4 Specialty 33%33%None
IONOSOL B-D5W IV SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IONOSOL MB-D5W IV SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IONOSOL T-D5W IV SOLUTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IOPIDINE 0.5% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IOPIDINE 1% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IPOL VIAL 40;8;32; UNT   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IPRATROPIUM BROMIDE 21MCG AEROSOL SPRAY   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IPRATROPIUM BROMIDE 42MCG AEROSOL SPRAY   1 Tier 1 Preferred Generic Brand $7.00$4.00None
IPRATROPIUM BROMIDE INHALATION SOLUTION 0.02% 60 X 2.5ML VIALSD   1 Tier 1 Preferred Generic Brand $7.00$4.00P
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION SOLUTION 0.5MG/3ML 33 CRTN   1 Tier 1 Preferred Generic Brand $7.00$4.00P
IQUIX 1.5% DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
IRESSA 250MG TABLET   4 Tier 4 Specialty 33%33%None
IRINOTECAN HCL INJECTION 20MG   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ISENTRESS 400MG TABLET   4 Tier 4 Specialty 33%33%None
ISMO 20MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISOCHRON 40MG TABLET SA   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOLYTE H IN 5% DEXTROSE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISOLYTE M IN 5% DEXTROSE INJECTION   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOLYTE P IN 5% DEXTROSE INJECTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISOLYTE S IN 5% DEXTROSE INJECTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
ISOLYTE S SOLUTION FOR INJECTION   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISONARIF 300-150MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
ISONIAZID 100MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISONIAZID 300MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISONIAZID 50MG/5ML SYRUP   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISONIAZID INJ 100MG/ML   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOPTIN SR 120MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISOPTIN SR 180MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISOPTIN SR 240MG (500 Count)   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISORDIL 40MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ISORDIL TABLETS 5MG 100 BOT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
Drug Name Tier
Nbr.		 Tier
Description		 30-Day
Preferred
Pharm		 90-Day
Mail
Order		 Drug
Usage
Mgmt
ISOSORBIDE DN 10MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 2.5MG TABLET SL   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 20MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 30MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 40MG TABLET SA   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 5MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE DN 5MG TABLET SL   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE MN 10MG TABLET   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOSORBIDE MONONITRATE TABLETS 20MG 100 TABLETS BOT   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
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOTON GENTAMICIN 60MG/100ML   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISOTON GENTAMICIN 80MG/100ML   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISRADIPINE CAPSULES 2.5MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISRADIPINE CAPSULES 5MG (100 CT)   1 Tier 1 Preferred Generic Brand $7.00$4.00None
ISTALOL 0.5% EYE DROPS   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $90.00$255.00None
ITRACONAZOLE 100MG CAPSULE   2 Tier 2 Generic Preferred Brand $42.00$111.00None
IV BUSULFEX 6MG 1 X 10ML VIALGL   4 Tier 4 Specialty 33%33%None
IXEMPRA KIT 45MG   4 Tier 4 Specialty 33%33%None

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D AARP MedicareRx Enhanced (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.