2011 Medicare Part D Plan Formulary Information |
FreedomBlue PPO Deluxe (PPO) (H3916-005-0)
Benefit Details
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The FreedomBlue PPO Deluxe (PPO) (H3916-005-0) Formulary Drugs Starting with the Letter R in Montour County, PA: CMS MA Region 6 which includes: PA
|
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 ![Compare how all Medicare Part D PDP plans in PA cover RABIES VACCINE RABAVERT INJECTION 2.5UNT/ML 1 DOSE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RALOXIFENE 60 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover RALOXIFENE 60 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RAMIPRIL 1.25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAMIPRIL 1.25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RAMIPRIL 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAMIPRIL 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RAMIPRIL 2.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAMIPRIL 2.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RAMIPRIL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAMIPRIL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RANEXA 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RANEXA 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RANEXA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RANEXA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RANITIDINE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RANITIDINE HCL 15MG/ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE HCL 15MG/ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RANITIDINE HCL 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE HCL 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RANITIDINE HCL 300MG CAPSULE (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE HCL 300MG CAPSULE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RANITIDINE TABLET 300MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE TABLET 300MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RANITIDINE TABLET USP 150MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE TABLET USP 150MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RAPAFLO CAPSULES 4MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover RAPAFLO CAPSULES 4MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAPAFLO CAPSULES 8MG 90 BOT ![Compare how all Medicare Part D PDP plans in PA cover RAPAFLO CAPSULES 8MG 90 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAPAMUNE 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAPAMUNE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RAPAMUNE 1MG/ML ORAL TUBEX ![Compare how all Medicare Part D PDP plans in PA cover RAPAMUNE 1MG/ML ORAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RAPAMUNE 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAPAMUNE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RAPAMUNE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover RAPAMUNE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RAZADYNE 12MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE 12MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RAZADYNE 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAZADYNE 8MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAZADYNE ER 16MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE ER 16MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAZADYNE ER 24MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE ER 24MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAZADYNE ER 8MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE ER 8MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RAZADYNE SOL 4MG/ML ![Compare how all Medicare Part D PDP plans in PA cover RAZADYNE SOL 4MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REBETOL 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REBETOL 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
REBETOL 40MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover REBETOL 40MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
REBIF 22MCG/0.5ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover REBIF 22MCG/0.5ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
REBIF 44MCG/0.5ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover REBIF 44MCG/0.5ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL ![Compare how all Medicare Part D PDP plans in PA cover REBIF TITRTN SOL PACK 8.8MCG/22 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RECLIPSEN 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in PA cover RECLIPSEN 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RECOMBIVAX HB 40MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover RECOMBIVAX HB 40MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REGLAN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REGLAN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REGLAN 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REGLAN 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REGONOL AMP 10MG 5ML ![Compare how all Medicare Part D PDP plans in PA cover REGONOL AMP 10MG 5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
REGRANEX 0.01% GEL ![Compare how all Medicare Part D PDP plans in PA cover REGRANEX 0.01% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RELENZA 5MG DISKHALER ![Compare how all Medicare Part D PDP plans in PA cover RELENZA 5MG DISKHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RELION R INJ 100/ML ![Compare how all Medicare Part D PDP plans in PA cover RELION R INJ 100/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RELISTOR SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover RELISTOR SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RELPAX 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RELPAX 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /25Days |
RELPAX 40MG TABLET 6X2 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RELPAX 40MG TABLET 6X2 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | Q:6 /25Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REMERON 15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REMERON 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMERON 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REMERON 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMERON 45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REMERON 45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN ![Compare how all Medicare Part D PDP plans in PA cover REMERON SLTABLET 15MG TABLET 30 BLPK CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN ![Compare how all Medicare Part D PDP plans in PA cover REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMERON SLTABLET 45MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REMERON SLTABLET 45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REMICADE 100MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover REMICADE 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RENAGEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RENAGEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RENAGEL 800MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RENAGEL 800MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RENAMIN 6.5% IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover RENAMIN 6.5% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RENVELA 800MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RENVELA 800MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REPREXAIN 5-200 MG TABLET 100 EA ![Compare how all Medicare Part D PDP plans in PA cover REPREXAIN 5-200 MG TABLET 100 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REPREXAIN TABLET ![Compare how all Medicare Part D PDP plans in PA cover REPREXAIN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
REPREXAIN TABLET ![Compare how all Medicare Part D PDP plans in PA cover REPREXAIN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 0.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 0.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REQUIP 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP XL ROPINIROLE HCL 2MG ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL ROPINIROLE HCL 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REQUIP XL ROPINIROLE HCL 4MG ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL ROPINIROLE HCL 4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP XL ROPINIROLE HCL 8MG ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL ROPINIROLE HCL 8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REQUIP XL TABLET 12 MG ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL TABLET 12 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RESCRIPTOR 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RESCRIPTOR 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RESCRIPTOR 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RESCRIPTOR 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RESERPINE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RESERPINE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RESERPINE 0.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RESERPINE 0.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU ![Compare how all Medicare Part D PDP plans in PA cover RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RETAPAMULIN 0.01 MG/MG TOPICAL OINTMENT [ALTABAX] ![Compare how all Medicare Part D PDP plans in PA cover RETAPAMULIN 0.01 MG/MG TOPICAL OINTMENT [ALTABAX].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A 0.01% GEL ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A 0.01% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A 0.025% CREAM ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RETIN-A 0.025% GEL ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A 0.025% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A MICRO 0.04% GEL ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A MICRO 0.04% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETIN-A MICRO 0.1% GEL ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A MICRO 0.1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETROVIR 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETROVIR 10MGML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 10MGML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETROVIR 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RETROVIR IV INFUSION VIAL ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR IV INFUSION VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
REVATIO 10 MG/12.5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REVATIO 10 MG/12.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
REVATIO 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REVATIO 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REVIA 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover REVIA 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
REVLIMID 10MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 10MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
REVLIMID 15MG CAPSULE 21 BOT ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 15MG CAPSULE 21 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
REVLIMID 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
REVLIMID 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
REYATAZ 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REYATAZ 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
REYATAZ 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REYATAZ 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
REYATAZ 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REYATAZ 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
REYATAZ 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REYATAZ 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RHEUMATREX 2.5MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover RHEUMATREX 2.5MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | P |
RHINOCORT AQUA NASAL SPRAY 32 MCG/SPRAY ![Compare how all Medicare Part D PDP plans in PA cover RHINOCORT AQUA NASAL SPRAY 32 MCG/SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIBAPAK 400-400MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover RIBAPAK 400-400MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBAPAK 600-400MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover RIBAPAK 600-400MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBAPAK 600-600MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in PA cover RIBAPAK 600-600MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBASPHERE 200MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIBASPHERE 400MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBASPHERE 600MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBASPHERE CAPSULES 200MG 42 BOT ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE CAPSULES 200MG 42 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBAVIRIN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIBAVIRIN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBAVIRIN 200MG TABLET 168 BOT ![Compare how all Medicare Part D PDP plans in PA cover RIBAVIRIN 200MG TABLET 168 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIBAVIRIN TABLETS 400MG 56 TABS BOT ![Compare how all Medicare Part D PDP plans in PA cover RIBAVIRIN TABLETS 400MG 56 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIBAVIRIN TABLETS 600MG 56 TABS BOT ![Compare how all Medicare Part D PDP plans in PA cover RIBAVIRIN TABLETS 600MG 56 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIDAURA 3MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIDAURA 3MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RIFADIN 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFADIN 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RIFADIN 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFADIN 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RIFADIN IV 600MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover RIFADIN IV 600MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RIFAMATE CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFAMATE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RIFAMPIN 150MG CAPSULE (30 CT) ![Compare how all Medicare Part D PDP plans in PA cover RIFAMPIN 150MG CAPSULE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIFAMPIN 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFAMPIN 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIFAMPIN 600MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover RIFAMPIN 600MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIFATER TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIFATER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RILUTEK 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RILUTEK 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RIMANTADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIMANTADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RINGERS INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover RINGERS INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RINGERS IRRIGATION 860-30 12X1000ML BAG ![Compare how all Medicare Part D PDP plans in PA cover RINGERS IRRIGATION 860-30 12X1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIOMET 500MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover RIOMET 500MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 0.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 0.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 1MG M-TAB ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 1MG M-TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RISPERDAL 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 1MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 1MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 2MG M-TAB ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 2MG M-TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 3MG M-TAB ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 3MG M-TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERDAL 3MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 4MG M-TAB ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 4MG M-TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERDAL CONSTA 25MG SYR ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL CONSTA 25MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RISPERDAL CONSTA 37.5MG SYR ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL CONSTA 37.5MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RISPERDAL CONSTA 50MG SYR ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL CONSTA 50MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | None |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
RISPERDAL M TABLET 0.5MG ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL M TABLET 0.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERIDONE 1 MG DISINTEGRATING TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 1 MG DISINTEGRATING TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE ORAL SOLUTION 1MG 30 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE ORAL SOLUTION 1MG 30 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RISPERIDONE TABLET 1 MG ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET 1 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLET 2 MG ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET 2 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLET 3 MG ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET 3 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLET 4 MG ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLET 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLETS 3MG 4 IN 1 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLETS 3MG 4 IN 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLETS 4MG 4 IN 1 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLETS 4MG 4 IN 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLETS ORALLY DISINTEGRATING 0.5MG 30 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLETS ORALLY DISINTEGRATING 0.5MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIDONE TABLETS ORALLY DISINTEGRATING 2MG 30 BLPK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE TABLETS ORALLY DISINTEGRATING 2MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RISPERIODONE TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIODONE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RITALIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RITALIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RITALIN 20MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RITALIN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RITALIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN LA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RITALIN LA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN LA 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RITALIN LA 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN LA 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RITALIN LA 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN LA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RITALIN LA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITALIN-SR 20MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover RITALIN-SR 20MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RITUXAN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover RITUXAN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | 33% | P |
RIVASTIGMINE TARTRATE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIVASTIGMINE TARTRATE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
RIVASTIGMINE TARTRATE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE TARTRATE CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROBAXIN 100MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ROBAXIN 100MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROBAXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROBAXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROBINUL 0.2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover ROBINUL 0.2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROBINUL 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROBINUL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROBINUL FORTE 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROBINUL FORTE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROCEPHIN FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover ROCEPHIN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROMYCIN 5MG/G OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover ROMYCIN 5MG/G OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE 6 MG EXTENDED RELEASE TABLET 24 HR [REQUIP] ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE 6 MG EXTENDED RELEASE TABLET 24 HR [REQUIP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROPINIROLE HCL TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE HCL TABLET 1 MG ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET 1 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL TABLET 2 MG ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET 2 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE HCL TABLET 3 MG ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET 3 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE HCL TABLET 4 MG ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE HCL TABLET 5 MG ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL TABLET 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROPINIROLE HYDROCLORIDE TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HYDROCLORIDE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROTATEQ VACCINE ![Compare how all Medicare Part D PDP plans in PA cover ROTATEQ VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
ROWASA RECTAL SUSPENSION ENEMA 4GM/60ML 7 X 60ML BOTUD ![Compare how all Medicare Part D PDP plans in PA cover ROWASA RECTAL SUSPENSION ENEMA 4GM/60ML 7 X 60ML BOTUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROXICET 5-325/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in PA cover ROXICET 5-325/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
ROXICET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $15.00 | None |
ROXICET 5/500 CAPLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICET 5/500 CAPLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$40.00 | $100.00 | None |
ROXICODONE 15MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROXICODONE 30MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROXICODONE TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
ROZEREM 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover ROZEREM 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL FILM COATED TABLETS 225 MG ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL FILM COATED TABLETS 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES ER 325MG 60 BOT ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES ER 325MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES EXTENDED RELEASE 225 MG ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES EXTENDED RELEASE 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES EXTENDED RELEASE 425 MG ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL SR PROPAFENONE HYDROCHLORIDE CAPSULES EXTENDED RELEASE 425 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYTHMOL TABLETS ![Compare how all Medicare Part D PDP plans in PA cover RYTHMOL TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYZOLT EXTENDED RELEASE TABLETS 100MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover RYZOLT EXTENDED RELEASE TABLETS 100MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
RYZOLT EXTENDED RELEASE TABLETS 200MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover RYZOLT EXTENDED RELEASE TABLETS 200MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RYZOLT EXTENDED RELEASE TABLETS 300MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover RYZOLT EXTENDED RELEASE TABLETS 300MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$80.00 | $200.00 | None |