2018 Medicare Part D Plan Formulary Information |
Express Scripts Medicare - Value (PDP) (S5660-122-0)
Benefit Details
 |
The Express Scripts Medicare - Value (PDP) (S5660-122-0) Formulary Drugs Starting with the Letter R in CMS PDP Region 20 which includes: MS Plan Monthly Premium: $33.30 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 |
$28.00 | $84.00 | None |
RADICAVA 30 MG/100 ML BAG  |
5 |
Specialty Tier |
25% | N/A | P |
RALOXIFENE HCL 60 MG TABLET [Evista] ![Compare how all Medicare Part D PDP plans in MS cover RALOXIFENE HCL 60 MG TABLET [Evista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RANEXA ER 1,000 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RANEXA ER 500 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RANITIDINE 15 MG/ML SYRUP  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RANITIDINE 150 MG CAPSULE  |
2 |
Generic |
$3.00 | $9.00 | None |
RANITIDINE 150 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RANITIDINE 300 MG CAPSULE  |
2 |
Generic |
$3.00 | $9.00 | None |
RANITIDINE 300 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RAPAMUNE 1MG/ML ORAL TUBEX  |
5 |
Specialty Tier |
25% | N/A | P |
Rasagiline Mesylate 0.5 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in MS cover Rasagiline Mesylate 0.5 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | None |
Rasagiline Mesylate 1 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in MS cover Rasagiline Mesylate 1 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | None |
RAVICTI 1.1 GRAM/ML LIQUID  |
5 |
Specialty Tier |
25% | N/A | None |
REBETOL 40MG/ML SOLUTION  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS  |
5 |
Specialty Tier |
25% | N/A | P Q:6 /28Days |
REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS  |
5 |
Specialty Tier |
25% | N/A | P Q:6 /28Days |
REBIF REBIDOSE 22 MCG/0.5 ML  |
5 |
Specialty Tier |
25% | N/A | P Q:6 /28Days |
REBIF REBIDOSE 44 MCG/0.5 ML  |
5 |
Specialty Tier |
25% | N/A | P Q:6 /28Days |
REBIF REBIDOSE TITRATION PACK  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /180Days |
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /180Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RECLIPSEN 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in MS cover RECLIPSEN 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | None |
RECOMBIVAX HB 10 MCG/ML SYR  |
3 |
Preferred Brand |
$28.00 | $84.00 | P |
RECOMBIVAX HB 40MCG/ML VIAL  |
3 |
Preferred Brand |
$28.00 | $84.00 | P |
RECTIV 0.4% OINTMENT  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
REGRANEX 0.01% GEL  |
5 |
Specialty Tier |
25% | N/A | None |
RELENZA 5MG DISKHALER  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RELISTOR 12 MG/0.6 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | None |
RELISTOR 12 MG/0.6 ML VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
RELISTOR 8 MG/0.4 ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | None |
REMICADE 100MG VIAL  |
5 |
Specialty Tier |
25% | N/A | P |
REMODULIN 10MG/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 |
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 |
RENVELA 800MG TABLET  |
5 |
Specialty Tier |
25% | N/A | None |
REPAGLINIDE 0.5 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in MS cover REPAGLINIDE 0.5 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | Q:992 /31Days |
REPAGLINIDE 1 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in MS cover REPAGLINIDE 1 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | Q:496 /31Days |
REPAGLINIDE 2 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in MS cover REPAGLINIDE 2 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | Q:248 /31Days |
REPATHA 140 MG/ML SURECLICK  |
5 |
Specialty Tier |
25% | N/A | P Q:3 /28Days |
REPATHA 140 MG/ML SYRINGE  |
5 |
Specialty Tier |
25% | N/A | P Q:3 /28Days |
REPATHA 420 MG/3.5ML PUSHTRONX  |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
RESCRIPTOR 100mg/1 360 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RESCRIPTOR 200 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RESTASIS 0.05% EYE EMULSION  |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:60 /30Days |
RETROVIR 200 MG/20 ML VIAL  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
REVLIMID 10 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REVLIMID 15MG CAPSULE 21 BOT  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REVLIMID 2.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REVLIMID 20 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REVLIMID 25 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REVLIMID 5 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | P |
REXULTI 0.25 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:496 /31Days |
REXULTI 0.5 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:248 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REXULTI 1 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:124 /31Days |
REXULTI 2 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:62 /31Days |
REXULTI 3 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:42 /31Days |
REXULTI 4 MG TABLET  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:31 /31Days |
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 |
RIBAVIRIN 200 MG CAPSULE  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RIBAVIRIN 200MG TABLET 168 BOT  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RIFABUTIN 150 MG CAPSULE [Mycobutin] ![Compare how all Medicare Part D PDP plans in MS cover RIFABUTIN 150 MG CAPSULE [Mycobutin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIFAMPIN 150 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIFAMPIN 300 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIFAMPIN IV 600 MG VIAL  |
2 |
Generic |
$3.00 | $9.00 | None |
RILUZOLE 50 MG TABLET [Rilutek] ![Compare how all Medicare Part D PDP plans in MS cover RILUZOLE 50 MG TABLET [Rilutek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
Rimantadine 100mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIOMET 500MG/5ML SOLUTION ORAL  |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:791 /31Days |
RISPERDAL CONSTA 25MG SYR  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RISPERDAL CONSTA 37.5MG SYR  |
5 |
Specialty Tier |
25% | N/A | None |
RISPERDAL CONSTA 50MG SYR  |
5 |
Specialty Tier |
25% | N/A | None |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RISPERIDONE 0.25 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:1984 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 0.5 MG ODT  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:992 /31Days |
RISPERIDONE 0.5 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:992 /31Days |
RISPERIDONE 1 MG ODT  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:496 /31Days |
RISPERIDONE 1 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:496 /31Days |
RISPERIDONE 1 MG/ML SOLUTION  |
4 |
Non-Preferred Drug |
48% | N/A | Q:496 /31Days |
RISPERIDONE 2 MG ODT  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:248 /31Days |
RISPERIDONE 2 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:248 /31Days |
RISPERIDONE 3 MG ODT  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:166 /31Days |
RISPERIDONE 3 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:166 /31Days |
RISPERIDONE 4 MG ODT  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:124 /31Days |
RISPERIDONE 4 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P Q:124 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK  |
4 |
Non-Preferred Drug |
48% | N/A | P Q:1984 /31Days |
RITALIN LA 10MG CAPSULE  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RITONAVIR 100 MG TABLET [Norvir] ![Compare how all Medicare Part D PDP plans in MS cover RITONAVIR 100 MG TABLET [Norvir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | 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 |
48% | N/A | None |
RIVASTIGMINE 13.3 MG/24HR PTCH  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RIVASTIGMINE 3 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIVASTIGMINE 4.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIVASTIGMINE 4.6 MG/24HR PATCH  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RIVASTIGMINE 6 MG CAPSULE  |
4 |
Non-Preferred Drug |
48% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE 9.5 MG/24HR PATCH  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
RIVELSA TABLET TBDSPK 3MO  |
4 |
Non-Preferred Drug |
48% | N/A | None |
RIZATRIPTAN 10 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in MS cover RIZATRIPTAN 10 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | Q:36 /28Days |
RIZATRIPTAN 10 MG TABLET [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in MS cover RIZATRIPTAN 10 MG TABLET [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | Q:36 /28Days |
RIZATRIPTAN 5 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in MS cover RIZATRIPTAN 5 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | Q:36 /28Days |
RIZATRIPTAN 5 MG TABLET [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in MS cover RIZATRIPTAN 5 MG TABLET [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
48% | N/A | Q:36 /28Days |
ROPINIROLE HCL 0.25 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROPINIROLE HCL 0.5 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROPINIROLE HCL 1 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROPINIROLE HCL 2 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROPINIROLE HCL 3 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL 4 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROPINIROLE HCL 5 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ROSUVASTATIN CALCIUM 10 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in MS cover ROSUVASTATIN CALCIUM 10 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:31 /31Days |
ROSUVASTATIN CALCIUM 20 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in MS cover ROSUVASTATIN CALCIUM 20 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:31 /31Days |
Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor] ![Compare how all Medicare Part D PDP plans in MS cover Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:31 /31Days |
ROSUVASTATIN CALCIUM 5 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in MS cover ROSUVASTATIN CALCIUM 5 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:31 /31Days |
ROTARIX VACCINE SUSPENSION  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
ROTATEQ VACCINE Solution  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
Roweepra 1,000 mg tablet  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
Roweepra 500 mg tablet  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
Roweepra 750 mg tablet  |
3 |
Preferred Brand |
$28.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROZEREM 8 MG TABLET  |
3 |
Preferred Brand |
$28.00 | $84.00 | Q:31 /31Days |
RUBRACA 200 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:186 /31Days |
RUBRACA 250 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:155 /31Days |
RUBRACA 300 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:124 /31Days |
RYDAPT 25 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P |