2016 Medicare Part D Plan Formulary Information |
Meridian Complete (Medicare-Medicaid Plan) (H6080-001-0)
Benefit Details
|
The Meridian Complete (Medicare-Medicaid Plan) (H6080-001-0) Formulary Drugs Starting with the Letter R in DuPage County, IL: CMS MA Region 14 which includes: IL Plan Monthly Premium: $0.00 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 |
2 |
Tier 2 |
0% | 0% | None |
Raloxifene HCl 60 mg tablet [Evista] |
1 |
Tier 1 |
0% | 0% | None |
RAMIPRIL 1.25MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
RAMIPRIL 10MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
RAMIPRIL 2.5MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
RAMIPRIL 5MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
RANEXA ER 1,000 MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RANEXA ER 500 MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RANITIDINE 150MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
Ranitidine 16.8mg/mL 473 mL in 1 BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Ranitidine 300mg/1 100 FILM COATED TABLETS in BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RANITIDINE HCL 150 MG/6 ML VL |
1 |
Tier 1 |
0% | 0% | None |
Ranitidine Hydrochloride 150mg/1 1000 FILM COATED TABLETS in BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
Ranitidine Hydrochloride 300mg/1 30 CAPSULE BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RAPAFLO CAPSULES 4MG 30 BOT |
2 |
Tier 2 |
0% | 0% | S |
RAPAFLO CAPSULES 8MG 90 BOT |
2 |
Tier 2 |
0% | 0% | S |
RAPAMUNE 0.5MG TABLETS |
2 |
Tier 2 |
0% | 0% | P |
RAPAMUNE 1MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RAPAMUNE 1MG/ML ORAL TUBEX |
2 |
Tier 2 |
0% | 0% | P |
RAPAMUNE 2MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RASUVO 10 MG/0.2 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RASUVO 12.5 MG/0.25 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 15 MG/0.3 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 17.5 MG/0.35 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 20 MG/0.4 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 22.5 MG/0.45 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 25 MG/0.5 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 27.5 MG/0.55 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 30 MG/0.6 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RASUVO 7.5 MG/0.15 ML AUTOINJ |
2 |
Tier 2 |
0% | 0% | None |
RAVICTI 1.1 GRAM/ML LIQUID |
2 |
Tier 2 |
0% | 0% | P |
REBETOL 40MG/ML SOLUTION |
2 |
Tier 2 |
0% | 0% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS |
2 |
Tier 2 |
0% | 0% | P |
REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS |
2 |
Tier 2 |
0% | 0% | P |
RECLAST 5MG/100ML INJECTION |
2 |
Tier 2 |
0% | 0% | P |
RECOMBIVAX HB 10 MCG/ML SYR |
2 |
Tier 2 |
0% | 0% | None |
RECOMBIVAX HB 40MCG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
RECOMBIVAX HB 5 MCG/0.5 ML SYR |
2 |
Tier 2 |
0% | 0% | None |
RELENZA 5MG DISKHALER |
2 |
Tier 2 |
0% | 0% | None |
RELISTOR 12 MG/0.6 ML VIAL |
2 |
Tier 2 |
0% | 0% | None |
REMERON 15MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REMERON 30MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REMERON 45MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN |
2 |
Tier 2 |
0% | 0% | None |
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN |
2 |
Tier 2 |
0% | 0% | None |
REMERON SLTABLET 45MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REMICADE 100MG VIAL |
2 |
Tier 2 |
0% | 0% | P |
REMODULIN 10MG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
REMODULIN 1MG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
REMODULIN 2.5MG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
REMODULIN 5MG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
RENAGEL 400MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RENAGEL 800MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RENVELA 800MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Repaglinide 0.5 MG Tablet [Prandin] |
1 |
Tier 1 |
0% | 0% | None |
Repaglinide 1 MG Tablet [Prandin] |
1 |
Tier 1 |
0% | 0% | None |
Repaglinide 2 MG Tablet [Prandin] |
1 |
Tier 1 |
0% | 0% | None |
REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet] |
1 |
Tier 1 |
0% | 0% | None |
REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet] |
1 |
Tier 1 |
0% | 0% | None |
RESCRIPTOR 100mg/1 360 TABLET BOTTLE |
2 |
Tier 2 |
0% | 0% | None |
RESCRIPTOR 200 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RESERPINE 0.1MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
Reserpine 0.25mg/1 100 TABLET BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RESTASIS CYCLOSPORINE OPTHALMIC EMULSION .05% 30 X 0.4 ML VIALSU |
2 |
Tier 2 |
0% | 0% | None |
RETROVIR 100mg/1 100 CAPSULE BOTTLE |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RETROVIR 10mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 20 mL in 1 VIAL, SINGLE-USE |
2 |
Tier 2 |
0% | 0% | None |
RETROVIR 50mg/5mL 240 mL in 1 BOTTLE |
2 |
Tier 2 |
0% | 0% | None |
REVLIMID 10MG CAPSULE (100 CT) |
2 |
Tier 2 |
0% | 0% | P |
REVLIMID 15MG CAPSULE 21 BOT |
2 |
Tier 2 |
0% | 0% | P |
REVLIMID 2.5 MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
REVLIMID 20 MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
REVLIMID 25MG CAPSULE (100 CT) |
2 |
Tier 2 |
0% | 0% | P |
REVLIMID 5MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
REXULTI 0.25 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REXULTI 0.5 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REXULTI 1 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REXULTI 2 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REXULTI 3 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REXULTI 4 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
REYATAZ 150MG CAPSULE |
2 |
Tier 2 |
0% | 0% | None |
REYATAZ 200MG CAPSULE |
2 |
Tier 2 |
0% | 0% | None |
REYATAZ 300MG CAPSULE |
2 |
Tier 2 |
0% | 0% | None |
REYATAZ 50 MG POWDER PACKET |
2 |
Tier 2 |
0% | 0% | None |
RHEUMATREX 2.5 MG TABLET 12 EA |
2 |
Tier 2 |
0% | 0% | None |
RHEUMATREX 2.5 MG TABLET 16 EA |
2 |
Tier 2 |
0% | 0% | None |
RHEUMATREX 2.5 MG TABLET 20 EA |
2 |
Tier 2 |
0% | 0% | None |
RHEUMATREX 2.5 MG TABLET 8 EA |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RHEUMATREX 2.5MG TABLET DOSE PACK |
2 |
Tier 2 |
0% | 0% | None |
RIBASPHERE 400MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RIBASPHERE 600MG TABLET |
2 |
Tier 2 |
0% | 0% | P |
RIBAVIRIN 200 MG CAPSULE |
1 |
Tier 1 |
0% | 0% | P |
RIBAVIRIN 200MG TABLET 168 BOT |
1 |
Tier 1 |
0% | 0% | P |
RIDAURA 3MG CAPSULE |
2 |
Tier 2 |
0% | 0% | None |
RIFAMATE 150/300 CAPSULE |
2 |
Tier 2 |
0% | 0% | None |
RIFAMPIN 150MG CAPSULE (30 CT) |
1 |
Tier 1 |
0% | 0% | None |
RIFAMPIN 300MG CAPSULE |
1 |
Tier 1 |
0% | 0% | None |
Rifampin IV 600 MG Vial |
1 |
Tier 1 |
0% | 0% | None |
RIFATER 50/300/120 TABLET |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RILUTEK 50 MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
riluzole 50 mg tablet [Rilutek] |
1 |
Tier 1 |
0% | 0% | None |
Rimantadine 100mg/1 100 TABLET BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RINGERS 33/30/860 INJECTION |
1 |
Tier 1 |
0% | 0% | None |
RIOMET 500MG/5ML SOLUTION ORAL |
2 |
Tier 2 |
0% | 0% | S |
RISEDRONATE SODIUM 150 MG TABLET [Actonel] |
1 |
Tier 1 |
0% | 0% | None |
RISPERDAL 0.25MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 0.5MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 1MG M-TAB |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 1MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 1MG/ML SOLUTION |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERDAL 2MG TABLET |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 3mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL 4mg/1 10 BLISTER PACK in 1 BOX, UNIT-DOSE / 10 TABLET in 1 BLISTER PACK |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL CONSTA 25MG SYR |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL CONSTA 37.5MG SYR |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL CONSTA 50MG SYR |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL M TABLET 0.5MG |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL M-TAB 2mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL M-TAB 3mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK |
2 |
Tier 2 |
0% | 0% | None |
RISPERDAL M-TAB 4mg/1 7 BLISTER PACK in 1 BOX / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK |
2 |
Tier 2 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 0.25 MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 0.5 MG 500 TABLET BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 0.5 MG ODT |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 1 MG 7 BLISTER PACK per CARTON / 4 TABLET, ORALLY DISINTEGRATING per BLISTER PACK |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 1 MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 1 MG/ML 30 mL in 1 BOTTLE |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 2 MG 60 FILM COATED TABLETS in BOTTLE, PLASTIC |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 2 MG ODT |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 3 MG 60 FILM COATED TABLETS in BOTTLE, PLASTIC |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE 4 MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK |
1 |
Tier 1 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE TABLETS 3MG 4 IN 1 BLPK |
1 |
Tier 1 |
0% | 0% | None |
RISPERIDONE TABLETS 4MG 4 IN 1 BLPK |
1 |
Tier 1 |
0% | 0% | None |
RITALIN LA 20MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
RITALIN LA 30MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
RITALIN LA 40MG CAPSULE |
2 |
Tier 2 |
0% | 0% | P |
RITUXAN 10MG/ML VIAL |
2 |
Tier 2 |
0% | 0% | P |
RIVASTIGMINE 13.3 MG/24HR PTCH |
1 |
Tier 1 |
0% | 0% | Q:30 /30Days |
RIVASTIGMINE 4.6 MG/24HR PATCH |
1 |
Tier 1 |
0% | 0% | Q:30 /30Days |
RIVASTIGMINE 9.5 MG/24HR PATCH |
1 |
Tier 1 |
0% | 0% | Q:30 /30Days |
RIVASTIGMINE TARTRATE 3MG CAPSULES |
1 |
Tier 1 |
0% | 0% | None |
RIVASTIGMINE TARTRATE 4.5MG CAPSULES |
1 |
Tier 1 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE TARTRATE 6MG CAPSULES |
1 |
Tier 1 |
0% | 0% | None |
RIVASTIGMINE TARTRATE1.5MG CAPSULES |
1 |
Tier 1 |
0% | 0% | None |
Rizatriptan 10 mg odt |
1 |
Tier 1 |
0% | 0% | None |
Rizatriptan 10 mg tablet |
1 |
Tier 1 |
0% | 0% | None |
Rizatriptan 5 mg odt |
1 |
Tier 1 |
0% | 0% | None |
Rizatriptan 5 mg tablet |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HCL 0.5MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HCL TABLET 1 MG |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HCL TABLET 2 MG |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HCL TABLET 3 MG |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HCL TABLET 4 MG |
1 |
Tier 1 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL TABLET 5 MG |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE HYDROCLORIDE 0.25MG TABLET |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE TAB 12MG ER |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE TAB 2MG ER |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE TAB 4MG ER |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE TAB 6MG ER |
1 |
Tier 1 |
0% | 0% | None |
ROPINIROLE TAB 8MG ER |
1 |
Tier 1 |
0% | 0% | None |
ROSUVASTATIN CALCIUM 10 MG TABLET [Crestor] |
1 |
Tier 1 |
0% | 0% | None |
ROSUVASTATIN CALCIUM 20 MG TABLET [Crestor] |
1 |
Tier 1 |
0% | 0% | None |
Rosuvastatin calcium 40 MG TABLET [Crestor] |
1 |
Tier 1 |
0% | 0% | None |
ROSUVASTATIN CALCIUM 5 MG TABLET [Crestor] |
1 |
Tier 1 |
0% | 0% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROTARIX VACCINE SUSPENSION |
2 |
Tier 2 |
0% | 0% | None |
ROTATEQ VACCINE |
2 |
Tier 2 |
0% | 0% | None |
ROZEREM 8MG TABLET (100 CT) |
2 |
Tier 2 |
0% | 0% | None |