2015 Medicare Part D Plan Formulary Information |
Freedom Blue PPO ValueRx (PPO) (H3916-033-0)
Benefit Details
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The Freedom Blue PPO ValueRx (PPO) (H3916-033-0) Formulary Drugs Starting with the Letter R in ELK County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $105.00 Deductible: $0 |
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 |
RABAVERT RABIES VACCINE KIT ![Compare how all Medicare Part D PDP plans in PA cover RABAVERT RABIES VACCINE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Rabeprazole Sodium DR 20 MG Tablet [AcipHex] ![Compare how all Medicare Part D PDP plans in PA cover Rabeprazole Sodium DR 20 MG Tablet [AcipHex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RAGWITEK SUBLINGUAL TABLET ![Compare how all Medicare Part D PDP plans in PA cover RAGWITEK SUBLINGUAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
Raloxifene HCl 60 mg tablet [Evista] ![Compare how all Medicare Part D PDP plans in PA cover Raloxifene HCl 60 mg tablet [Evista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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 |
Preferred Generic |
$4.00 | $10.00 | 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 |
Preferred Generic |
$4.00 | $10.00 | 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 |
Preferred Generic |
$4.00 | $10.00 | 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 |
Preferred Generic |
$4.00 | $10.00 | None |
RANEXA ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RANEXA ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
RANEXA ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RANEXA ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
Preferred Generic |
$4.00 | $10.00 | None |
Ranitidine 16.8mg/mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Ranitidine 16.8mg/mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Ranitidine 300mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Ranitidine 300mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RANITIDINE HCL 150 MG/6 ML VL ![Compare how all Medicare Part D PDP plans in PA cover RANITIDINE HCL 150 MG/6 ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Ranitidine Hydrochloride 150mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Ranitidine Hydrochloride 150mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Ranitidine Hydrochloride 300mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Ranitidine Hydrochloride 300mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | 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 |
Preferred Brand |
$45.00 | $112.50 | 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 |
Preferred Brand |
$45.00 | $112.50 | None |
RAPAMUNE 0.5MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover RAPAMUNE 0.5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
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) |
5 |
Specialty Tier |
33% | 33% | 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) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
5 |
Specialty Tier |
33% | 33% | P |
RASUVO 10 MG/0.2 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 10 MG/0.2 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 12.5 MG/0.25 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 12.5 MG/0.25 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 15 MG/0.3 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 15 MG/0.3 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 17.5 MG/0.35 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 17.5 MG/0.35 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 20 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 20 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 22.5 MG/0.45 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 22.5 MG/0.45 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 25 MG/0.5 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 25 MG/0.5 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 27.5 MG/0.55 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 27.5 MG/0.55 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 30 MG/0.6 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 30 MG/0.6 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RASUVO 7.5 MG/0.15 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in PA cover RASUVO 7.5 MG/0.15 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RAVICTI 1.1 GRAM/ML LIQUID ![Compare how all Medicare Part D PDP plans in PA cover RAVICTI 1.1 GRAM/ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
5 |
Specialty Tier |
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 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in PA cover REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in PA cover REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REBIF REBIDOSE 22 MCG/0.5 ML ![Compare how all Medicare Part D PDP plans in PA cover REBIF REBIDOSE 22 MCG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
REBIF REBIDOSE 44 MCG/0.5 ML ![Compare how all Medicare Part D PDP plans in PA cover REBIF REBIDOSE 44 MCG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
REBIF REBIDOSE TITRATION PACK ![Compare how all Medicare Part D PDP plans in PA cover REBIF REBIDOSE TITRATION PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
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) |
5 |
Specialty Tier |
33% | 33% | None |
RECLAST 5MG/100ML INJECTION ![Compare how all Medicare Part D PDP plans in PA cover RECLAST 5MG/100ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RECOMBIVAX HB 10 MCG/ML SYR ![Compare how all Medicare Part D PDP plans in PA cover RECOMBIVAX HB 10 MCG/ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
RECOMBIVAX HB 5 MCG/0.5 ML SYR ![Compare how all Medicare Part D PDP plans in PA cover RECOMBIVAX HB 5 MCG/0.5 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
RECTIV 0.4% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover RECTIV 0.4% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
5 |
Specialty Tier |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
RELISTOR 12 MG/0.6 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover RELISTOR 12 MG/0.6 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RELISTOR 12 MG/0.6 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover RELISTOR 12 MG/0.6 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RELISTOR 8 MG/0.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover RELISTOR 8 MG/0.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:12 /31Days |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | Q:6 /31Days |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
5 |
Specialty Tier |
33% | 33% | None |
REMODULIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REMODULIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
REMODULIN 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REMODULIN 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
REMODULIN 2.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REMODULIN 2.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
REMODULIN 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover REMODULIN 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Repaglinide 0.5 MG Tablet [Prandin] ![Compare how all Medicare Part D PDP plans in PA cover Repaglinide 0.5 MG Tablet [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Repaglinide 1 MG Tablet [Prandin] ![Compare how all Medicare Part D PDP plans in PA cover Repaglinide 1 MG Tablet [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Repaglinide 2 MG Tablet [Prandin] ![Compare how all Medicare Part D PDP plans in PA cover Repaglinide 2 MG Tablet [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Reprexain 10-200 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Reprexain 10-200 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | P |
Reprexain 2.5-200 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Reprexain 2.5-200 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | P |
Reprexain 5-200 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Reprexain 5-200 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | P |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REQUIP XL 2mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL 2mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
REQUIP XL 4mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL 4mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
REQUIP XL 6mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL 6mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
REQUIP XL 8mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover REQUIP XL 8mg/1 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RESCRIPTOR 100mg/1 360 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover RESCRIPTOR 100mg/1 360 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
RESCRIPTOR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RESCRIPTOR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
Reserpine 0.25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Reserpine 0.25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Retin-A MICRO 0.1mg/g 1 BOTTLE, PUMP in 1 CARTON / 50 g in 1 BOTTLE, PUMP ![Compare how all Medicare Part D PDP plans in PA cover Retin-A MICRO 0.1mg/g 1 BOTTLE, PUMP in 1 CARTON / 50 g in 1 BOTTLE, PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RETIN-A MICRO PUMP 0.08% GEL ![Compare how all Medicare Part D PDP plans in PA cover RETIN-A MICRO PUMP 0.08% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RETROVIR 100mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 100mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RETROVIR 10mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 20 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 10mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 20 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
RETROVIR 50mg/5mL 240 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover RETROVIR 50mg/5mL 240 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
REVATIO 0.8mg/mL 12.5 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in PA cover REVATIO 0.8mg/mL 12.5 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REVATIO 10 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in PA cover REVATIO 10 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
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) |
5 |
Specialty Tier |
33% | 33% | P |
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) |
5 |
Specialty Tier |
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) |
5 |
Specialty Tier |
33% | 33% | P |
REVLIMID 2.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 2.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
REVLIMID 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover REVLIMID 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
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) |
5 |
Specialty Tier |
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) |
5 |
Specialty Tier |
33% | 33% | P |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REYATAZ 50 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in PA cover REYATAZ 50 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RHEUMATREX 2.5 MG TABLET 12 EA ![Compare how all Medicare Part D PDP plans in PA cover RHEUMATREX 2.5 MG TABLET 12 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
RHEUMATREX 2.5 MG TABLET 16 EA ![Compare how all Medicare Part D PDP plans in PA cover RHEUMATREX 2.5 MG TABLET 16 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
RHEUMATREX 2.5 MG TABLET 20 EA ![Compare how all Medicare Part D PDP plans in PA cover RHEUMATREX 2.5 MG TABLET 20 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
RHEUMATREX 2.5 MG TABLET 8 EA ![Compare how all Medicare Part D PDP plans in PA cover RHEUMATREX 2.5 MG TABLET 8 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | P |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
5 |
Specialty Tier |
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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIBASPHERE RibaPak ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE RibaPak .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
RIBASPHERE RibaPak 400mg/1 ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE RibaPak 400mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
RIBASPHERE RibaPak 600mg/1 ![Compare how all Medicare Part D PDP plans in PA cover RIBASPHERE RibaPak 600mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
RIBAVIRIN 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIBAVIRIN 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
RIFABUTIN 150 MG CAPSULE [Mycobutin] ![Compare how all Medicare Part D PDP plans in PA cover RIFABUTIN 150 MG CAPSULE [Mycobutin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RIFADIN 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFADIN 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RIFAMATE 150/300 CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover RIFAMATE 150/300 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
Rifampin IV 600 MG Vial ![Compare how all Medicare Part D PDP plans in PA cover Rifampin IV 600 MG Vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RIFATER 50/300/120 TABLET ![Compare how all Medicare Part D PDP plans in PA cover RIFATER 50/300/120 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RILUTEK 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RILUTEK 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
riluzole 50 mg tablet [Rilutek] ![Compare how all Medicare Part D PDP plans in PA cover riluzole 50 mg tablet [Rilutek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Rimantadine 100mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Rimantadine 100mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RINGERS 33/30/860 INJECTION ![Compare how all Medicare Part D PDP plans in PA cover RINGERS 33/30/860 INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISEDRONATE SODIUM 150 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM 150 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISEDRONATE SODIUM 30 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM 30 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RISEDRONATE SODIUM 5 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM 5 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RISEDRONATE SODIUM DR 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in PA cover RISEDRONATE SODIUM DR 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERDAL 3mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 3mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISPERDAL 4mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL 4mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
5 |
Specialty Tier |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISPERDAL M-TAB 2mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL M-TAB 2mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISPERDAL M-TAB 3mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL M-TAB 3mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISPERDAL M-TAB 4mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERDAL M-TAB 4mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RISPERIDONE 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 0.5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 0.5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 0.5mg/1 7 BLISTER PACK in 1 CARTON / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 0.5mg/1 7 BLISTER PACK in 1 CARTON / 4 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 1mg/1 7 BLISTER PACK per CARTON / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 1mg/1 7 BLISTER PACK per CARTON / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 1mg/mL 30 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 1mg/mL 30 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 2mg/1 20 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTE ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 2mg/1 20 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, ORALLY DISINTEGRATING in 1 BLISTE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 2mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 2mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 3mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 3mg/1 60 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
RISPERIDONE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover RISPERIDONE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
Preferred Generic |
$4.00 | $10.00 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | 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) |
5 |
Specialty Tier |
33% | 33% | None |
RIVASTIGMINE TARTRATE 3MG CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE 3MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RIVASTIGMINE TARTRATE 4.5MG CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE 4.5MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE TARTRATE 6MG CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE 6MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
RIVASTIGMINE TARTRATE1.5MG CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover RIVASTIGMINE TARTRATE1.5MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
rizatriptan 10 mg odt ![Compare how all Medicare Part D PDP plans in PA cover rizatriptan 10 mg odt.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:12 /31Days |
rizatriptan 10 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover rizatriptan 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:12 /31Days |
rizatriptan 5 mg odt ![Compare how all Medicare Part D PDP plans in PA cover rizatriptan 5 mg odt.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:24 /31Days |
rizatriptan 5 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover rizatriptan 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:24 /31Days |
Rocaltrol 0.25ug GELATIN COATED 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Rocaltrol 0.25ug GELATIN COATED 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
Rocaltrol 0.5ug GELATIN COATED 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Rocaltrol 0.5ug GELATIN COATED 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
Rocaltrol 1ug/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Rocaltrol 1ug/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
ROPINIROLE HCL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HCL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE HYDROCLORIDE 0.25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE HYDROCLORIDE 0.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE TAB 12MG ER ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE TAB 12MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE TAB 2MG ER ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE TAB 2MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE TAB 4MG ER ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE TAB 4MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE TAB 6MG ER ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE TAB 6MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROPINIROLE TAB 8MG ER ![Compare how all Medicare Part D PDP plans in PA cover ROPINIROLE TAB 8MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $37.50 | None |
ROTARIX VACCINE SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover ROTARIX VACCINE SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:1908 /31Days |
ROXICODONE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
ROXICODONE 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
ROXICODONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover ROXICODONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
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) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
RUCONEST 2,100 UNIT VIAL ![Compare how all Medicare Part D PDP plans in PA cover RUCONEST 2,100 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |