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Humana Walmart-Preferred Rx Plan (PDP) (S5884-114-0)
Tier 1 (352)
Tier 2 (1024)
Tier 3 (900)
Tier 4 (1212)

Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
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Cick on the first letter of your drug name to browse the formulary:

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2011 Medicare Part D Plan Formulary Information
Humana Walmart-Preferred Rx Plan (PDP) (S5884-114-0)
Benefit Details           
The Humana Walmart-Preferred Rx Plan (PDP) (S5884-114-0)
Formulary Drugs Starting with the Letter R

in CMS PDP Region 32 which includes: CA
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   3 Non-Preferred Generic/Preferred Brand 20%20%None
RALOXIFENE 60 MG ORAL TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%Q:30
/30Days
RAMIPRIL 1.25MG CAPSULE   2 Generic $5.00$0.00None
RAMIPRIL 10MG CAPSULE   2 Generic $5.00$0.00None
RAMIPRIL 2.5MG CAPSULE   2 Generic $5.00$0.00None
RAMIPRIL 5MG CAPSULE   2 Generic $5.00$0.00None
RANEXA 1,000 MG TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%S Q:120
/30Days
RANEXA 500 MG TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%S Q:120
/30Days
RANITIDINE 150MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
RANITIDINE HCL 15MG/ML SYRUP   2 Generic $5.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RANITIDINE HCL 25MG/ML VIAL   2 Generic $5.00$0.00None
RANITIDINE HCL 300MG CAPSULE (30 CT)   2 Generic $5.00$0.00None
RANITIDINE TABLET 300MG (100 CT)   1 Preferred Generic $2.00$0.00None
RANITIDINE TABLET USP 150MG (500 CT)   1 Preferred Generic $2.00$0.00None
RAPAMUNE 1MG TABLET   4 Non-Preferred Brand 35%35%P
RAPAMUNE 1MG/ML ORAL TUBEX   4 Non-Preferred Brand 35%35%P
RAPAMUNE 2MG TABLET   4 Non-Preferred Brand 35%35%P
RAPAMUNE TABLETS   4 Non-Preferred Brand 35%35%P
REBETOL 40MG/ML SOLUTION   4 Non-Preferred Brand 35%35%P Q:1000
/30Days
REBIF 22MCG/0.5ML SYRINGE   4 Non-Preferred Brand 35%35%P Q:12
/30Days
REBIF 44MCG/0.5ML SYRINGE   4 Non-Preferred Brand 35%35%P Q:12
/30Days
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 Non-Preferred Brand 35%35%P Q:12
/30Days
RECLAST INJECTION   4 Non-Preferred Brand 35%35%P Q:1
/365Days
RECLIPSEN 0.15-0.03 TABLET   2 Generic $5.00$0.00None
RECOMBIVAX HB 40MCG/ML VIAL   4 Non-Preferred Brand 35%35%None
REGRANEX 0.01% GEL   4 Non-Preferred Brand 35%35%None
RELENZA 5MG DISKHALER   4 Non-Preferred Brand 35%35%Q:60
/180Days
RELION R INJ 100/ML   3 Non-Preferred Generic/Preferred Brand 20%20%None
RELISTOR SOLUTION   4 Non-Preferred Brand 35%35%P Q:36
/30Days
REMICADE 100MG VIAL   4 Non-Preferred Brand 35%35%P
REMODULIN 10MG/ML VIAL   4 Non-Preferred Brand 35%35%P
REMODULIN 1MG/ML VIAL   4 Non-Preferred Brand 35%35%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REMODULIN 2.5MG/ML VIAL   4 Non-Preferred Brand 35%35%P
REMODULIN 5MG/ML VIAL   4 Non-Preferred Brand 35%35%P
RENAMIN 6.5% IV SOLUTION   4 Non-Preferred Brand 35%35%None
RENVELA 800MG TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%Q:540
/30Days
RESCRIPTOR 100MG TABLET   4 Non-Preferred Brand 35%35%None
RESCRIPTOR 200MG TABLET   4 Non-Preferred Brand 35%35%None
RESERPINE 0.1MG TABLET   2 Generic $5.00$0.00None
RESERPINE 0.25MG TABLET   2 Generic $5.00$0.00None
RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU   3 Non-Preferred Generic/Preferred Brand 20%20%None
RETAPAMULIN 0.01 MG/MG TOPICAL OINTMENT [ALTABAX]   4 Non-Preferred Brand 35%35%None
RETROVIR 100MG CAPSULE   4 Non-Preferred Brand 35%35%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RETROVIR 10MGML SYRUP   4 Non-Preferred Brand 35%35%None
RETROVIR 300MG TABLET   4 Non-Preferred Brand 35%35%None
RETROVIR IV INFUSION VIAL   4 Non-Preferred Brand 35%35%None
REVATIO 10 MG/12.5 ML VIAL   4 Non-Preferred Brand 35%35%P Q:1125
/30Days
REVATIO 20MG TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%P Q:90
/30Days
REVLIMID 10MG CAPSULE (100 CT)   4 Non-Preferred Brand 35%35%P Q:30
/30Days
REVLIMID 15MG CAPSULE 21 BOT   4 Non-Preferred Brand 35%35%P Q:30
/30Days
REVLIMID 25MG CAPSULE (100 CT)   4 Non-Preferred Brand 35%35%P Q:30
/30Days
REVLIMID 5MG CAPSULE   4 Non-Preferred Brand 35%35%P Q:30
/30Days
REYATAZ 100MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
REYATAZ 150MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REYATAZ 200MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
REYATAZ 300MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
RHEUMATREX 2.5MG TABLET DOSE PACK   4 Non-Preferred Brand 35%35%None
RIBAVIRIN 200MG CAPSULE   4 Non-Preferred Brand 35%35%P
RIBAVIRIN 200MG TABLET 168 BOT   2 Generic $5.00$0.00P
RIBAVIRIN TABLETS 400MG 56 TABS BOT   3 Non-Preferred Generic/Preferred Brand 20%20%Q:112
/30Days
RIBAVIRIN TABLETS 600MG 56 TABS BOT   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RIDAURA 3MG CAPSULE   4 Non-Preferred Brand 35%35%None
RIFAMATE CAPSULE   4 Non-Preferred Brand 35%35%None
RIFAMPIN 150MG CAPSULE (30 CT)   3 Non-Preferred Generic/Preferred Brand 20%20%None
RIFAMPIN 300MG CAPSULE   3 Non-Preferred Generic/Preferred Brand 20%20%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RIFAMPIN 600MG VIAL   3 Non-Preferred Generic/Preferred Brand 20%20%None
RILUTEK 50MG TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%None
RIMANTADINE 100MG TABLET   2 Generic $5.00$0.00None
RINGERS INJECTION 1000ML BAG   2 Generic $5.00$0.00None
RINGERS IRRIGATION 860-30 12X1000ML BAG   2 Generic $5.00$0.00None
RISPERDAL 1MG M-TAB   4 Non-Preferred Brand 35%35%Q:60
/30Days
RISPERDAL 1MG/ML SOLUTION   4 Non-Preferred Brand 35%35%None
RISPERDAL 2MG M-TAB   4 Non-Preferred Brand 35%35%Q:60
/30Days
RISPERDAL 3MG M-TAB   4 Non-Preferred Brand 35%35%Q:60
/30Days
RISPERDAL 4MG M-TAB   4 Non-Preferred Brand 35%35%Q:60
/30Days
RISPERDAL CONSTA 25MG SYR   4 Non-Preferred Brand 35%35%Q:2
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERDAL CONSTA 37.5MG SYR   4 Non-Preferred Brand 35%35%None
RISPERDAL CONSTA 50MG SYR   4 Non-Preferred Brand 35%35%None
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL   4 Non-Preferred Brand 35%35%Q:2
/28Days
RISPERDAL M TABLET 0.5MG   4 Non-Preferred Brand 35%35%Q:120
/30Days
RISPERIDONE 1 MG DISINTEGRATING TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RISPERIDONE ORAL SOLUTION 1MG 30 ML BOTDR   3 Non-Preferred Generic/Preferred Brand 20%20%None
RISPERIDONE TABLET   2 Generic $5.00$0.00Q:60
/30Days
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RISPERIDONE TABLET 1 MG   2 Generic $5.00$0.00Q:60
/30Days
RISPERIDONE TABLET 2 MG   2 Generic $5.00$0.00Q:60
/30Days
RISPERIDONE TABLET 3 MG   2 Generic $5.00$0.00Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERIDONE TABLET 4 MG   2 Generic $5.00$0.00Q:60
/30Days
RISPERIDONE TABLETS 3MG 4 IN 1 BLPK   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RISPERIDONE TABLETS 4MG 4 IN 1 BLPK   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RISPERIDONE TABLETS ORALLY DISINTEGRATING 0.5MG 30 BLPK   3 Non-Preferred Generic/Preferred Brand 20%20%Q:120
/30Days
RISPERIDONE TABLETS ORALLY DISINTEGRATING 2MG 30 BLPK   3 Non-Preferred Generic/Preferred Brand 20%20%Q:60
/30Days
RISPERIODONE TABLET   2 Generic $5.00$0.00Q:120
/30Days
RITUXAN 10MG/ML VIAL   3 Non-Preferred Generic/Preferred Brand 20%20%P
RIVASTIGMINE TARTRATE CAPSULES   2 Generic $5.00$0.00Q:90
/30Days
RIVASTIGMINE TARTRATE CAPSULES   2 Generic $5.00$0.00Q:90
/30Days
RIVASTIGMINE TARTRATE CAPSULES   2 Generic $5.00$0.00Q:60
/30Days
RIVASTIGMINE TARTRATE CAPSULES   2 Generic $5.00$0.00Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROBAXIN 100MG/ML VIAL   4 Non-Preferred Brand 35%35%None
ROBAXIN 500MG TABLET   4 Non-Preferred Brand 35%35%None
ROBINUL 0.2MG/ML VIAL   4 Non-Preferred Brand 35%35%None
ROBINUL 1MG TABLET   4 Non-Preferred Brand 35%35%None
ROBINUL FORTE 2MG TABLET   4 Non-Preferred Brand 35%35%None
ROCEPHIN FOR INJECTION   4 Non-Preferred Brand 35%35%None
ROMYCIN 5MG/G OINTMENT   1 Preferred Generic $2.00$0.00None
ROPINIROLE HCL TABLET   2 Generic $5.00$0.00None
ROPINIROLE HCL TABLET 1 MG   2 Generic $5.00$0.00None
ROPINIROLE HCL TABLET 2 MG   2 Generic $5.00$0.00None
ROPINIROLE HCL TABLET 3 MG   2 Generic $5.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROPINIROLE HCL TABLET 4 MG   2 Generic $5.00$0.00None
ROPINIROLE HCL TABLET 5 MG   2 Generic $5.00$0.00None
ROPINIROLE HYDROCLORIDE TABLET   2 Generic $5.00$0.00None
ROTATEQ VACCINE   4 Non-Preferred Brand 35%35%None
ROXICET 5/325 TABLET   3 Non-Preferred Generic/Preferred Brand 20%20%Q:360
/30Days
ROXICET 5/500 CAPLET   3 Non-Preferred Generic/Preferred Brand 20%20%Q:240
/30Days

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D Humana Walmart-Preferred Rx Plan (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 intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $(2840)) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, on the 2011 Humana Walmart-Preferred Rx Plan the pricing 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 2011 )

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.