2018 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Select (PDP) (S5810-292-0)
Benefit Details
 |
The Aetna Medicare Rx Select (PDP) (S5810-292-0) Formulary Drugs Starting with the Letter R in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $17.70 Deductible: $405 Qualifies for LIS: No |
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 VIAL  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex] ![Compare how all Medicare Part D PDP plans in LA cover RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | S |
RALOXIFENE HCL 60 MG TABLET [Evista] ![Compare how all Medicare Part D PDP plans in LA cover RALOXIFENE HCL 60 MG TABLET [Evista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | None |
RAMIPRIL 1.25 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RAMIPRIL 10 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RAMIPRIL 2.5 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RAMIPRIL 5 MG CAPSULE  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RANEXA ER 1,000 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RANEXA ER 500 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RANITIDINE 15 MG/ML SYRUP  |
2* |
Generic |
$3.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RANITIDINE 150 MG CAPSULE  |
2* |
Generic |
$3.00 | N/A | None |
RANITIDINE 150 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RANITIDINE 300 MG CAPSULE  |
2* |
Generic |
$3.00 | N/A | None |
RANITIDINE 300 MG TABLET  |
1* |
Preferred Generic |
$0.00 | N/A | None |
RANITIDINE HCL 50 MG/2 ML VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RAPAFLO 8 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RAPAFLO CAPSULES 4MG 30 BOT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RAPAMUNE 0.5MG TABLETS  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RAPAMUNE 1MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RAPAMUNE 1MG/ML ORAL TUBEX  |
5 |
Specialty Tier |
25% | N/A | P |
RAPAMUNE 2MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Rasagiline Mesylate 0.5 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in LA cover Rasagiline Mesylate 0.5 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | None |
Rasagiline Mesylate 1 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in LA cover Rasagiline Mesylate 1 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 10 MG/0.2 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 12.5 MG/0.25 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 15 MG/0.3 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 17.5 MG/0.35 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 20 MG/0.4 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 22.5 MG/0.45 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 25 MG/0.5 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 30 MG/0.6 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RASUVO 7.5 MG/0.15 ML AUTOINJ  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RAVICTI 1.1 GRAM/ML LIQUID  |
5 |
Specialty Tier |
25% | N/A | P |
RAYOS DR 1 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
RAYOS DR 2 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
RAYOS DR 5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
RAZADYNE 12MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:60 /30Days |
RAZADYNE 4MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:60 /30Days |
RAZADYNE 8MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:60 /30Days |
RAZADYNE ER 16MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
RAZADYNE ER 24MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
RAZADYNE ER 8MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | S Q:30 /30Days |
REBETOL 40MG/ML SOLUTION  |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RECLAST 5MG/100ML INJECTION  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RECLIPSEN 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in LA cover RECLIPSEN 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | None |
RECOMBIVAX HB 10 MCG/ML SYR  |
3 |
Preferred Brand |
$46.00 | N/A | P |
RECOMBIVAX HB 40MCG/ML VIAL  |
3 |
Preferred Brand |
$46.00 | N/A | P |
RECTIV 0.4% OINTMENT  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REGRANEX 0.01% GEL  |
5 |
Specialty Tier |
25% | N/A | P |
RELENZA 5MG DISKHALER  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RELISTOR 12 MG/0.6 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P |
RELISTOR 12 MG/0.6 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
RELISTOR 8 MG/0.4 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P |
RELPAX 20MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RELPAX 40 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
REMERON 15MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REMERON 30MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REMERON SLTABLET 45MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REMICADE 100MG VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
REMODULIN 10MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
REMODULIN 1MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
REMODULIN 2.5MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
REMODULIN 5MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RENAGEL 800MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | S |
RENVELA 800MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
REPAGLINIDE 0.5 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in LA cover REPAGLINIDE 0.5 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | N/A | Q:120 /30Days |
REPAGLINIDE 1 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in LA cover REPAGLINIDE 1 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | N/A | Q:120 /30Days |
REPAGLINIDE 2 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in LA cover REPAGLINIDE 2 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | N/A | Q:240 /30Days |
REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in LA cover REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | N/A | Q:150 /30Days |
REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in LA cover REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | N/A | Q:150 /30Days |
REQUIP 0.25 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP 0.5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP 1MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP 2MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REQUIP 3MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP 4MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REQUIP XL 2 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
REQUIP XL 4 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | Q:150 /30Days |
REQUIP XL 6 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | Q:120 /30Days |
REQUIP XL 8 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
REQUIP XL TABLET 12 MG  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RESCRIPTOR 100mg/1 360 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RESCRIPTOR 200 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RESTASIS 0.05% EYE EMULSION  |
3 |
Preferred Brand |
$46.00 | N/A | Q:64 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RESTORIL 15mg/1 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RESTORIL 22.5mg/1 30 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RESTORIL 30mg/1 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RESTORIL 7.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RETIN-A 0.01% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETIN-A 0.025% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETIN-A MICRO 0.04% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETIN-A MICRO 0.1% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETIN-A MICRO PUMP 0.06% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETIN-A MICRO PUMP 0.08% GEL  |
4 |
Non-Preferred Drug |
37% | N/A | P |
RETROVIR 100mg/1 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RETROVIR 200 MG/20 ML VIAL  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RETROVIR 50mg/5mL 240 mL in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
REVATIO 0.8 MG/ML 12.5 mL in 1 VIAL, SINGLE-USE  |
5 |
Specialty Tier |
25% | N/A | P Q:1125 /30Days |
REVATIO 10 MG/ML ORAL SUSP  |
5 |
Specialty Tier |
25% | N/A | P Q:224 /30Days |
REVATIO 20MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
REVLIMID 10 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
REVLIMID 15MG CAPSULE 21 BOT  |
5 |
Specialty Tier |
25% | N/A | P |
REVLIMID 2.5 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
REVLIMID 20 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
REVLIMID 25 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
REVLIMID 5 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REXULTI 0.25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:360 /30Days |
REXULTI 0.5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:180 /30Days |
REXULTI 1 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:90 /30Days |
REXULTI 2 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
REXULTI 3 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
REXULTI 4 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
REYATAZ 150MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
REYATAZ 200MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
REYATAZ 300MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
REYATAZ 50 MG POWDER PACKET  |
5 |
Specialty Tier |
25% | N/A | None |
RIBASPHERE 200 MG CAPSULE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIBASPHERE 200MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIBASPHERE 400MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIBASPHERE 600MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIBASPHERE RibaPak  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Ribasphere RibaPak 200-400 mg  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIBASPHERE RibaPak 400mg/1  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIBASPHERE RibaPak 600mg/1  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIBAVIRIN 200 MG CAPSULE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIBAVIRIN 200MG TABLET 168 BOT  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIDAURA 3 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | None |
RIFABUTIN 150 MG CAPSULE [Mycobutin] ![Compare how all Medicare Part D PDP plans in LA cover RIFABUTIN 150 MG CAPSULE [Mycobutin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIFADIN 150MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIFAMPIN 150 MG CAPSULE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIFAMPIN 300 MG CAPSULE  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIFAMPIN IV 600 MG VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIFATER 50/300/120 TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RILUTEK 50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
RILUZOLE 50 MG TABLET [Rilutek] ![Compare how all Medicare Part D PDP plans in LA cover RILUZOLE 50 MG TABLET [Rilutek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | None |
Rimantadine 100mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RIOMET 500MG/5ML SOLUTION ORAL  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:4 /28Days |
RISEDRONATE SODIUM 150 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SODIUM 150 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:1 /28Days |
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 LA cover RISEDRONATE SODIUM 30 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RISEDRONATE SODIUM 35 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SODIUM 35 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:12 /84Days |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:12 /84Days |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:12 /84Days |
RISEDRONATE SODIUM 5 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in LA cover RISEDRONATE SODIUM 5 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RISPERDAL 0.25 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
RISPERDAL 0.5 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
RISPERDAL 1 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RISPERDAL 1MG/ML SOLUTION  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RISPERDAL 2 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RISPERDAL 3 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERDAL 4 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:120 /30Days |
RISPERDAL CONSTA 25MG SYR  |
4 |
Non-Preferred Drug |
37% | N/A | Q:2 /28Days |
RISPERDAL CONSTA 37.5MG SYR  |
5 |
Specialty Tier |
25% | N/A | Q:2 /28Days |
RISPERDAL CONSTA 50MG SYR  |
5 |
Specialty Tier |
25% | N/A | Q:2 /28Days |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL  |
4 |
Non-Preferred Drug |
37% | N/A | Q:2 /28Days |
RISPERIDONE 0.25 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:90 /30Days |
RISPERIDONE 0.5 MG ODT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
RISPERIDONE 0.5 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:90 /30Days |
RISPERIDONE 1 MG ODT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RISPERIDONE 1 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:60 /30Days |
RISPERIDONE 1 MG/ML SOLUTION  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 2 MG ODT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RISPERIDONE 2 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:60 /30Days |
RISPERIDONE 3 MG ODT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
RISPERIDONE 3 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:90 /30Days |
RISPERIDONE 4 MG ODT  |
4 |
Non-Preferred Drug |
37% | N/A | Q:120 /30Days |
RISPERIDONE 4 MG TABLET  |
3 |
Preferred Brand |
$46.00 | N/A | Q:120 /30Days |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
RITALIN 10MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:90 /30Days |
RITALIN 20MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:90 /30Days |
RITALIN 5MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:90 /30Days |
RITALIN LA 10MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RITALIN LA 20MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:30 /30Days |
RITALIN LA 30MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:60 /30Days |
RITALIN LA 40MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | P Q:30 /30Days |
RITONAVIR 100 MG TABLET [Norvir] ![Compare how all Medicare Part D PDP plans in LA cover RITONAVIR 100 MG TABLET [Norvir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | None |
RITUXAN 10 MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
RITUXAN 10MG/ML VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
RIVASTIGMINE 1.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RIVASTIGMINE 13.3 MG/24HR PTCH  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RIVASTIGMINE 3 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RIVASTIGMINE 4.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RIVASTIGMINE 4.6 MG/24HR PATCH  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE 6 MG CAPSULE  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
RIVASTIGMINE 9.5 MG/24HR PATCH  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RIVELSA TABLET TBDSPK 3MO  |
3 |
Preferred Brand |
$46.00 | N/A | None |
RIZATRIPTAN 10 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in LA cover RIZATRIPTAN 10 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
RIZATRIPTAN 10 MG TABLET [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in LA cover RIZATRIPTAN 10 MG TABLET [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
RIZATRIPTAN 5 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in LA cover RIZATRIPTAN 5 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
RIZATRIPTAN 5 MG TABLET [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in LA cover RIZATRIPTAN 5 MG TABLET [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:12 /30Days |
ROBINUL 1MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
ROBINUL FORTE 2MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Rocaltrol 0.25ug GELATIN COATED 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Rocaltrol 0.5ug GELATIN COATED 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Rocaltrol 1ug/mL 15 mL in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
ROPINIROLE HCL 0.25 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 0.5 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 1 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 2 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 3 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 4 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL 5 MG TABLET  |
2* |
Generic |
$3.00 | N/A | None |
ROPINIROLE HCL ER 12 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:60 /30Days |
ROPINIROLE HCL ER 2 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
ROPINIROLE HCL ER 4 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL ER 6 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:120 /30Days |
ROPINIROLE HCL ER 8 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:90 /30Days |
ROSUVASTATIN CALCIUM 10 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in LA cover ROSUVASTATIN CALCIUM 10 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
ROSUVASTATIN CALCIUM 20 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in LA cover ROSUVASTATIN CALCIUM 20 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor] ![Compare how all Medicare Part D PDP plans in LA cover Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
ROSUVASTATIN CALCIUM 5 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in LA cover ROSUVASTATIN CALCIUM 5 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$46.00 | N/A | Q:30 /30Days |
ROTARIX VACCINE SUSPENSION  |
3 |
Preferred Brand |
$46.00 | N/A | None |
ROTATEQ VACCINE Solution  |
3 |
Preferred Brand |
$46.00 | N/A | None |
Roweepra 1,000 mg tablet  |
2* |
Generic |
$3.00 | N/A | None |
Roweepra 500 mg tablet  |
2* |
Generic |
$3.00 | N/A | None |
Roweepra 750 mg tablet  |
2* |
Generic |
$3.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROWEEPRA XR 500 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | None |
ROWEEPRA XR 750 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
37% | N/A | None |
ROXICODONE 15 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:180 /30Days |
ROXICODONE 30 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:120 /30Days |
ROXICODONE 5 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:180 /30Days |
ROZEREM 8 MG TABLET  |
4 |
Non-Preferred Drug |
37% | N/A | Q:30 /30Days |
RUBRACA 200 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
RUBRACA 250 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
RUBRACA 300 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
RYDAPT 25 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |
RYTARY ER 23.75 MG-95 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RYTARY ER 36.25 MG-145 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RYTARY ER 48.75 MG-195 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RYTARY ER 61.25 MG-245 MG CAP  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RYTHMOL SR 225mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RYTHMOL SR 325mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |
RYTHMOL SR 425mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE  |
4 |
Non-Preferred Drug |
37% | N/A | None |