Q1GROUP LLC | Q1Medicare.com - a non-government resource for the Medicare community
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

AARP MedicareRx Preferred (PDP) (S5820-002-0)
Tier 1 (124)
Tier 2 (733)
Tier 3 (978)
Tier 4 (1214)
Tier 5 (656)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2018 Medicare Part D Plan Formulary Information
AARP MedicareRx Preferred (PDP) (S5820-002-0)
Benefit Details           
The AARP MedicareRx Preferred (PDP) (S5820-002-0)
Formulary Drugs Starting with the Letter C

in CMS PDP Region 2 which includes: CT MA RI VT
Plan Monthly Premium: $78.00 Deductible: $0 Qualifies for LIS: No
Drugs Starting with Letter C

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
CABERGOLINE 0.5 MG TABLET   3 Preferred Brand $38.00$99.00None
CABOMETYX 20 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
CABOMETYX 40 MG TABLET   5 Specialty Tier 33%33%P Q:60
/30Days
CABOMETYX 60 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
CALCIPOTRIENE 0.005% CREAM   4 Non-Preferred Drug 38%38%None
CALCIPOTRIENE 0.005% SOLUTION   4 Non-Preferred Drug 38%38%None
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY   3 Preferred Brand $38.00$99.00Q:4
/28Days
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol]   2 Generic $12.00$0.00P
CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol]   2 Generic $12.00$0.00P
Calcitriol 1 MCG per 1 ML Injection   4 Non-Preferred Drug 38%38%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CALCITRIOL 1MCG/ML SOLUTION ORAL   2 Generic $12.00$0.00P
CALCITRIOL 3 MCG/G OINTMENT   4 Non-Preferred Drug 38%38%None
CALCIUM ACETATE 667 MG TABLET   3 Preferred Brand $38.00$99.00None
CALCIUM ACETATE CAPSULE 667 MG   3 Preferred Brand $38.00$99.00None
Calcium Chloride 0.002 MEQ/ML / Potassium Chloride 0.004 MEQ/ML / Sodium Chloride 0.147 MEQ/ML Injec   4 Non-Preferred Drug 38%38%None
CALQUENCE 100 MG CAPSULE   5 Specialty Tier 33%33%P Q:60
/30Days
CAMILA 0.35 MG TABLET   3 Preferred Brand $38.00$99.00None
CAMRESE LO TABLET   4 Non-Preferred Drug 38%38%None
CANASA 1,000 MG SUPPOSITORY   4 Non-Preferred Drug 38%38%None
CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION per CARTON   4 Non-Preferred Drug 38%38%None
CAPRELSA 100 MG TABLET   5 Specialty Tier 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CAPRELSA 300 MG TABLET   5 Specialty Tier 33%33%P
CAPTOPRIL 100MG TABLET   2 Generic $12.00$0.00Q:120
/30Days
CAPTOPRIL 12.5MG TABLET   2 Generic $12.00$0.00Q:90
/30Days
CAPTOPRIL 25 MG TABLET   2 Generic $12.00$0.00Q:90
/30Days
CAPTOPRIL 50MG TABLET   2 Generic $12.00$0.00Q:270
/30Days
Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE   2 Generic $12.00$0.00Q:90
/30Days
Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE   2 Generic $12.00$0.00Q:60
/30Days
Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE   2 Generic $12.00$0.00Q:90
/30Days
Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE   2 Generic $12.00$0.00Q:60
/30Days
CARAFATE SUS 1GM/10ML   4 Non-Preferred Drug 38%38%None
CARBAGLU 200 MG DISPER TABLET   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARBAMAZEPINE 100 MG TAB CHEW   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE 100 MG/5 ML SUSP   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE 200 MG TABLET   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE ER 100 MG CAP CPMP 12HR [Carbatrol]   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE ER 100 MG TABLET   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE ER 200 MG CAP CPMP 12HR [Carbatrol]   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE ER 300 MG CAP CPMP 12HR [Carbatrol]   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE XR 200 MG TABLET   3 Preferred Brand $38.00$99.00None
CARBAMAZEPINE XR 400 MG TABLET   3 Preferred Brand $38.00$99.00None
Carbidopa 25mg Tab 100 [Lodosyn]   4 Non-Preferred Drug 38%38%None
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT   2 Generic $12.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT   2 Generic $12.00$0.00None
CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT   2 Generic $12.00$0.00None
CARBIDOPA-LEVO ER 25-100 TAB   2 Generic $12.00$0.00None
CARBIDOPA-LEVO ER 50-200 TAB   2 Generic $12.00$0.00None
CARBIDOPA-LEVODOPA 10-100 TAB   2 Generic $12.00$0.00None
CARBIDOPA-LEVODOPA 25-100 TAB   2 Generic $12.00$0.00None
CARBIDOPA-LEVODOPA 25-250 TAB   2 Generic $12.00$0.00None
CARBIDOPA-LEVODOPA-ENTA 150 MG   4 Non-Preferred Drug 38%38%None
CARBIDOPA-LEVODOPA-ENTA 75 MG   4 Non-Preferred Drug 38%38%None
CARBIDOPA-LEVODOPA-ENTACAPONE 100 MG [Stalevo]   4 Non-Preferred Drug 38%38%None
CARBIDOPA-LEVODOPA-ENTACAPONE 125 MG [Stalevo]   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARBIDOPA-LEVODOPA-ENTACAPONE 200 MG [Stalevo]   4 Non-Preferred Drug 38%38%None
CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo]   4 Non-Preferred Drug 38%38%None
Carboplatin 10 MG/ML Injectable Solution   4 Non-Preferred Drug 38%38%None
CARDENE-NACL 20 MG/200 ML SOLN   4 Non-Preferred Drug 38%38%None
CARDENE-NACL 40 MG/200 ML IV   4 Non-Preferred Drug 38%38%None
CARIMUNE NF 6GM VIAL   4 Non-Preferred Drug 38%38%P
CARTEOLOL HCL 1% EYE DROPS   2 Generic $12.00$0.00None
CARTIA XT 120MG CAPSULE SA   3 Preferred Brand $38.00$99.00None
CARTIA XT 180MG CAPSULE SA   3 Preferred Brand $38.00$99.00None
CARTIA XT 240MG CAPSULE SA   3 Preferred Brand $38.00$99.00None
CARTIA XT 300 MG CAPSULE   3 Preferred Brand $38.00$99.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CARVEDILOL 12.5 MG TABLET   1 Preferred Generic $4.00$0.00None
CARVEDILOL 25 MG TABLET   1 Preferred Generic $4.00$0.00None
CARVEDILOL 3.125 MG TABLET   1 Preferred Generic $4.00$0.00None
CARVEDILOL 6.25 MG TABLET   1 Preferred Generic $4.00$0.00None
CAYSTON KIT 75 MG/VIAL   5 Specialty Tier 33%33%P
CAZIANT 28 DAY TABLET   4 Non-Preferred Drug 38%38%None
CEFACLOR 250 MG CAPSULES   2 Generic $12.00$0.00None
CEFACLOR 500 MG CAPSULES   2 Generic $12.00$0.00None
CEFADROXIL 250 MG/5 ML SUSP   2 Generic $12.00$0.00None
CEFADROXIL 500 MG CAPSULE   2 Generic $12.00$0.00None
CEFADROXIL 500 MG/5 ML SUSP   2 Generic $12.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFAZOLIN 1 GM VIAL 25/Box   4 Non-Preferred Drug 38%38%None
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE   4 Non-Preferred Drug 38%38%None
CEFAZOLIN 500 MG VIAL   4 Non-Preferred Drug 38%38%None
CEFDINIR 125 MG/5 ML SUSP   3 Preferred Brand $38.00$99.00None
CEFDINIR 250 MG/5 ML SUSP   3 Preferred Brand $38.00$99.00None
CEFDINIR 300 MG CAPSULE   3 Preferred Brand $38.00$99.00None
CEFEPIME HCL 1 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFEPIME HCL 2 GRAM VIAL   4 Non-Preferred Drug 38%38%None
CEFIXIME 100 MG/5 ML SUSP [Suprax]   4 Non-Preferred Drug 38%38%None
CEFIXIME 200 MG/5 ML SUSP [Suprax]   4 Non-Preferred Drug 38%38%None
Cefotaxime 500 MG Injection   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Cefotaxime sodium 1 gm vial   4 Non-Preferred Drug 38%38%None
Cefotaxime sodium 2 gm vial   4 Non-Preferred Drug 38%38%None
CEFOTETAN 1GM VIAL 1EA x 10   4 Non-Preferred Drug 38%38%None
CEFOTETAN 2GM VIAL 1EA x 10   4 Non-Preferred Drug 38%38%None
CEFOXITIN 1 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFOXITIN 10 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFOXITIN 2 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFPODOXIME 100 MG TABLET   4 Non-Preferred Drug 38%38%None
CEFPODOXIME 100 MG/5 ML SUSP   4 Non-Preferred Drug 38%38%None
CEFPODOXIME 200 MG TABLET   4 Non-Preferred Drug 38%38%None
CEFPODOXIME 50 MG/5 ML SUSP   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFPROZIL 125 MG/5 ML SUSP   3 Preferred Brand $38.00$99.00None
CEFPROZIL 250 MG TABLET   3 Preferred Brand $38.00$99.00None
CEFPROZIL 250 MG/5 ML SUSP   3 Preferred Brand $38.00$99.00None
CEFPROZIL 500 MG TABLET   3 Preferred Brand $38.00$99.00None
CEFTAZIDIME 1 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN   4 Non-Preferred Drug 38%38%None
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN   4 Non-Preferred Drug 38%38%None
CEFTRIAXONE 1 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFTRIAXONE 10 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFTRIAXONE 2 GM VIAL   4 Non-Preferred Drug 38%38%None
CEFTRIAXONE 250 MG VIAL   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEFTRIAXONE 500 MG VIAL   4 Non-Preferred Drug 38%38%None
CEFUROXIME 1.5 GM/VIAL FOR INJECTION   4 Non-Preferred Drug 38%38%None
CEFUROXIME 750 MG FOR INJECTION   4 Non-Preferred Drug 38%38%None
Cefuroxime 95 MG/ML Injectable Solution   4 Non-Preferred Drug 38%38%None
CEFUROXIME AXETIL 250 MG TAB   2 Generic $12.00$0.00None
CEFUROXIME AXETIL 500 MG TAB   2 Generic $12.00$0.00None
CELECOXIB 100 MG CAPSULE [Celebrex]   4 Non-Preferred Drug 38%38%Q:60
/30Days
CELECOXIB 200 MG CAPSULE [Celebrex]   4 Non-Preferred Drug 38%38%Q:60
/30Days
CELECOXIB 400 MG CAPSULE [Celebrex]   4 Non-Preferred Drug 38%38%Q:60
/30Days
CELECOXIB 50 MG CAPSULE [Celebrex]   4 Non-Preferred Drug 38%38%Q:60
/30Days
CELONTIN 300 MG KAPSEAL   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CEPHALEXIN 125 MG/5 ML SUSP   2 Generic $12.00$0.00None
CEPHALEXIN 250 MG CAPSULE   2 Generic $12.00$0.00None
CEPHALEXIN 250 MG/5 ML SUSP   2 Generic $12.00$0.00None
CEPHALEXIN 500 MG CAPSULE   2 Generic $12.00$0.00None
CEPHALEXIN 750 MG CAPSULE   2 Generic $12.00$0.00None
CEREZYME 400 UNITS VIAL   5 Specialty Tier 33%33%P
CETIRIZINE HCL 1 MG/ML SOLN   2 Generic $12.00$0.00None
CHANTIX 0.5 MG TABLET   3 Preferred Brand $38.00$99.00None
CHANTIX 1 MG CONT MONTH BOX   3 Preferred Brand $38.00$99.00None
CHANTIX 1 MG TABLET   3 Preferred Brand $38.00$99.00None
CHANTIX STARTING MONTH BOX   3 Preferred Brand $38.00$99.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHEMET 100 MG CAPSULE   4 Non-Preferred Drug 38%38%None
CHENODAL 250 MG TABLET   5 Specialty Tier 33%33%None
CHLORAMPHEN NA SUCC 1GM VL   4 Non-Preferred Drug 38%38%None
CHLORDIAZEPOXIDE 10 MG CAPSULE   2 Generic $12.00$0.00None
CHLORDIAZEPOXIDE 25 MG CAPSULE   2 Generic $12.00$0.00None
CHLORDIAZEPOXIDE 5 MG CAPSULE   2 Generic $12.00$0.00None
CHLORHEXIDINE GLUCONATE 0.12% RINSE   2 Generic $12.00$0.00None
CHLOROQUINE PH 250 MG TABLET   2 Generic $12.00$0.00None
CHLOROQUINE PH 500 MG TABLET   2 Generic $12.00$0.00None
CHLOROTHIAZIDE 250 MG TABLET   2 Generic $12.00$0.00None
Chlorothiazide 500 MG Injection   4 Non-Preferred Drug 38%38%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Chlorothiazide 500mg 100 TABLET BOTTLE   2 Generic $12.00$0.00None
CHLORPROMAZINE 10 MG TABLET   4 Non-Preferred Drug 38%38%None
CHLORPROMAZINE 100 MG TABLET   4 Non-Preferred Drug 38%38%None
CHLORPROMAZINE 200 MG TABLET   4 Non-Preferred Drug 38%38%None
CHLORPROMAZINE 25 MG TABLET   4 Non-Preferred Drug 38%38%None
CHLORPROMAZINE 25 MG/ML AMP   4 Non-Preferred Drug 38%38%None
CHLORPROMAZINE 50 MG TABLET   4 Non-Preferred Drug 38%38%None
CHLORTHALIDONE 25 MG TABLET (100 CT)   2 Generic $12.00$0.00None
CHLORTHALIDONE 50 MG TABLET   2 Generic $12.00$0.00None
CHLORZOXAZONE 500 MG TABLET   3 Preferred Brand $38.00$99.00None
CHOLBAM 250 MG CAPSULE   5 Specialty Tier 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CHOLBAM 50 MG CAPSULE   5 Specialty Tier 33%33%P
CHOLESTYRAMINE LIGHT POWDER   3 Preferred Brand $38.00$99.00None
CHOLESTYRAMINE PACKET   3 Preferred Brand $38.00$99.00None
CHORIONIC GONAD 10000U VIAL   4 Non-Preferred Drug 38%38%P
CICLOPIROX 0.77% CREAM   3 Preferred Brand $38.00$99.00None
CICLOPIROX 0.77% GEL   3 Preferred Brand $38.00$99.00None
CICLOPIROX 0.77% TOPICAL SUSP   3 Preferred Brand $38.00$99.00None
CICLOPIROX 1% SHAMPOO   3 Preferred Brand $38.00$99.00None
CICLOPIROX 8% SOLUTION   3 Preferred Brand $38.00$99.00None
CIDOFOVIR 375 MG/5 ML VIAL [Vistide]   5 Specialty Tier 33%33%None
Cilastatin 250 MG / Imipenem 250 MG Injection   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Cilastatin 500 MG / Imipenem 500 MG Injection   4 Non-Preferred Drug 38%38%None
CILOSTAZOL 100 MG TABLET   2 Generic $12.00$0.00None
CILOSTAZOL 50 MG TABLET   2 Generic $12.00$0.00None
CILOXAN 0.3% OINTMENT   4 Non-Preferred Drug 38%38%None
Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL   5 Specialty Tier 33%33%P
CIPRO HC OTIC SUSPENSION   4 Non-Preferred Drug 38%38%None
CIPRODEX OTIC SUSPENSION   3 Preferred Brand $38.00$99.00None
CIPROFLOXACIN 0.3% EYE DROP [Ciloxan]   2 Generic $12.00$0.00None
CIPROFLOXACIN 250 MG TABLET (100 CT) [Cipro]   2 Generic $12.00$0.00None
CIPROFLOXACIN 250 MG/5 ML SUSP MC REC [Cipro]   4 Non-Preferred Drug 38%38%None
CIPROFLOXACIN 500 MG/5 ML SUSP MC REC [Cipro]   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CIPROFLOXACIN HCL 500 MG Tablet [Cipro]   2 Generic $12.00$0.00None
CIPROFLOXACIN HCL 750 MG Tablet [Cipro]   2 Generic $12.00$0.00None
CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro]   4 Non-Preferred Drug 38%38%None
CISPLATIN 50MG/50ML MDV   4 Non-Preferred Drug 38%38%None
CITALOPRAM HBR 10 MG TABLET   1 Preferred Generic $4.00$0.00None
CITALOPRAM HBR 10 MG/5 ML SOLN   3 Preferred Brand $38.00$99.00None
CITALOPRAM HBR 20 MG TABLET   1 Preferred Generic $4.00$0.00None
CITALOPRAM HBR 40 MG TABLET   1 Preferred Generic $4.00$0.00None
Cladribine 1 MG/ML in 10 ML Injection   5 Specialty Tier 33%33%P
CLARAVIS 10 MG CAPSULE   4 Non-Preferred Drug 38%38%P
CLARAVIS 20 MG CAPSULE   4 Non-Preferred Drug 38%38%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK   4 Non-Preferred Drug 38%38%P
CLARAVIS 40 MG CAPSULE   4 Non-Preferred Drug 38%38%P
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION   4 Non-Preferred Drug 38%38%None
CLARITHROMYCIN 250 MG TABLET   3 Preferred Brand $38.00$99.00None
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION   4 Non-Preferred Drug 38%38%None
CLARITHROMYCIN 500 MG TABLET   3 Preferred Brand $38.00$99.00None
CLARITHROMYCIN ER 500 MG TAB   3 Preferred Brand $38.00$99.00None
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG   4 Non-Preferred Drug 38%38%None
Clindamycin 150 MG/ML 2ml   4 Non-Preferred Drug 38%38%None
CLINDAMYCIN 150mg/ml vl 25x6ml   4 Non-Preferred Drug 38%38%None
CLINDAMYCIN 75 MG/5 ML SOLN   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLINDAMYCIN HCL 150 MG CAPSULE   2 Generic $12.00$0.00None
CLINDAMYCIN HCL 300 MG CAPSULE   2 Generic $12.00$0.00None
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE   2 Generic $12.00$0.00None
CLINDAMYCIN PH 1% SOLUTION   3 Preferred Brand $38.00$99.00None
CLINDAMYCIN PH 600 MG/4 ML VL   4 Non-Preferred Drug 38%38%None
CLINDAMYCIN PHOSP 1% LOTION   3 Preferred Brand $38.00$99.00None
Clindamycin Phosphate and Benzoyl Peroxide 1 KIT   4 Non-Preferred Drug 38%38%None
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE   3 Preferred Brand $38.00$99.00None
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX   3 Preferred Brand $38.00$99.00None
CLINDAMYCIN PHOSPHATE VAGINAL CREAM   3 Preferred Brand $38.00$99.00None
Clindamycin-d5w 300 mg/50 ml   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Clindamycin-d5w 600 mg/50 ml   4 Non-Preferred Drug 38%38%None
Clindamycin-d5w 900 mg/50 ml   4 Non-Preferred Drug 38%38%None
CLOBETASOL 0.05% OINTMENT   4 Non-Preferred Drug 38%38%None
CLOBETASOL 0.05% SOLUTION   3 Preferred Brand $38.00$99.00None
CLOBETASOL EMOLLIENT 0.05% CRM   4 Non-Preferred Drug 38%38%None
Clobetasol Propionate 0.5 MG/ML Medicated Shampoo   4 Non-Preferred Drug 38%38%None
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE   4 Non-Preferred Drug 38%38%None
CLOFARABINE 20 MG/20 ML VIAL [Clolar]   5 Specialty Tier 33%33%None
CLOMIPRAMINE 25 MG CAPSULE   4 Non-Preferred Drug 38%38%None
CLOMIPRAMINE 50 MG CAPSULE   4 Non-Preferred Drug 38%38%None
CLOMIPRAMINE 75 MG CAPSULE   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLONAZEPAM 0.125 MG DIS TAB RAPDIS [Klonopin]   4 Non-Preferred Drug 38%38%Q:120
/30Days
CLONAZEPAM 0.25 MG ODT TAB RAPDIS [Klonopin]   4 Non-Preferred Drug 38%38%Q:120
/30Days
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin]   4 Non-Preferred Drug 38%38%Q:120
/30Days
CLONAZEPAM 0.5 MG TABLET [Klonopin]   2 Generic $12.00$0.00Q:120
/30Days
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin]   4 Non-Preferred Drug 38%38%Q:120
/30Days
CLONAZEPAM 1 MG TABLET [Klonopin]   2 Generic $12.00$0.00Q:120
/30Days
CLONAZEPAM 2 MG ODT TAB RAPDIS [Klonopin]   4 Non-Preferred Drug 38%38%Q:300
/30Days
CLONAZEPAM 2 MG TABLET [Klonopin]   2 Generic $12.00$0.00Q:300
/30Days
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH   4 Non-Preferred Drug 38%38%None
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH   4 Non-Preferred Drug 38%38%None
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLONIDINE HCL 0.1 MG TABLET   2 Generic $12.00$0.00None
CLONIDINE HCL 0.2 MG TABLET   2 Generic $12.00$0.00None
CLONIDINE HCL 0.3 MG TABLET   2 Generic $12.00$0.00None
CLONIDINE HCL ER 0.1 MG TABLET   4 Non-Preferred Drug 38%38%P
CLOPIDOGREL 75 MG TABLET [Plavix]   2 Generic $12.00$0.00Q:120
/30Days
CLORAZEPATE 15 MG TABLET   2 Generic $12.00$0.00Q:180
/30Days
CLORAZEPATE 3.75 MG TABLET   2 Generic $12.00$0.00Q:720
/30Days
CLORAZEPATE 7.5 MG TABLET   2 Generic $12.00$0.00Q:360
/30Days
CLOTRIMAZOLE 1% CREAM   2 Generic $12.00$0.00None
CLOTRIMAZOLE 1% SOLUTION   2 Generic $12.00$0.00None
CLOTRIMAZOLE 10 MG TROCHE   2 Generic $12.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CLOTRIMAZOLE-BETAMETHASONE LOT   4 Non-Preferred Drug 38%38%None
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE   3 Preferred Brand $38.00$99.00None
CLOZAPINE 100 MG TABLET [Clozaril]   3 Preferred Brand $38.00$99.00None
CLOZAPINE 200 MG TABLET   3 Preferred Brand $38.00$99.00None
CLOZAPINE 25 MG TABLET [Clozaril]   3 Preferred Brand $38.00$99.00None
CLOZAPINE 50 MG TABLET   3 Preferred Brand $38.00$99.00None
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo]   4 Non-Preferred Drug 38%38%Q:270
/30Days
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo]   4 Non-Preferred Drug 38%38%Q:60
/30Days
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo]   4 Non-Preferred Drug 38%38%Q:180
/30Days
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo]   4 Non-Preferred Drug 38%38%Q:120
/30Days
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo]   4 Non-Preferred Drug 38%38%Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COARTEM 20MG-120MG   4 Non-Preferred Drug 38%38%None
CODEINE SULFATE 15 mg tablet   3 Preferred Brand $38.00$99.00Q:180
/30Days
CODEINE SULFATE 30 mg tablet   3 Preferred Brand $38.00$99.00Q:180
/30Days
CODEINE SULFATE 60 mg tablet   3 Preferred Brand $38.00$99.00Q:180
/30Days
COLCHICINE 0.6 MG CAPSULE [Mitigare]   3 Preferred Brand $38.00$99.00Q:120
/30Days
COLCHICINE 0.6 MG TABLET [Colcrys]   3 Preferred Brand $38.00$99.00Q:120
/30Days
COLESEVELAM 625 MG TABLET [WelChol]   3 Preferred Brand $38.00$99.00None
COLESTIPOL HCL 1G TABLET   3 Preferred Brand $38.00$99.00None
COLESTIPOL HCL GRANULES PACKET   4 Non-Preferred Drug 38%38%None
COLISTIMETHATE 150 MG VIAL   4 Non-Preferred Drug 38%38%None
COLOCORT 100MG ENEMA   3 Preferred Brand $38.00$99.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COLY-MYCIN S OTIC SUSP DROP   4 Non-Preferred Drug 38%38%None
COMBIGAN 0.2%-0.5% DROPS   3 Preferred Brand $38.00$99.00None
COMBIVENT RESPIMAT INHAL SPRAY   3 Preferred Brand $38.00$99.00None
COMETRIQ 100 MG DAILY-DOSE PK   5 Specialty Tier 33%33%P
COMETRIQ 140 MG DAILY-DOSE PK   5 Specialty Tier 33%33%P
COMETRIQ 60 MG DAILY-DOSE PACK   5 Specialty Tier 33%33%P
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1   5 Specialty Tier 33%33%Q:60
/30Days
COMPRO 25MG SUPPOSITORY   4 Non-Preferred Drug 38%38%None
CONSTULOSE 10 GM/15 ML SOLN   2 Generic $12.00$0.00None
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN   5 Specialty Tier 33%33%None
COPAXONE 40 MG/ML SYRINGE   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CORDRAN 4 MCG/SQ CM TAPE LARGE   4 Non-Preferred Drug 38%38%None
CORLANOR 5 MG TABLET   4 Non-Preferred Drug 38%38%P Q:60
/30Days
CORLANOR 7.5 MG TABLET   4 Non-Preferred Drug 38%38%P Q:60
/30Days
Cortisone 25 MG Tablet   4 Non-Preferred Drug 38%38%None
CORTISPORIN CRE 0.5%   4 Non-Preferred Drug 38%38%None
CORTISPORIN OINTMENT   4 Non-Preferred Drug 38%38%None
COSENTYX 300 MG DOSE-2 PENS   5 Specialty Tier 33%33%P
COSMEGEN 0.5 MG VIAL   5 Specialty Tier 33%33%None
COSOPT PF EYE DROPS   4 Non-Preferred Drug 38%38%None
COTELLIC 20 MG TABLET   5 Specialty Tier 33%33%P Q:90
/30Days
COUMADIN 1 MG TABLET   3 Preferred Brand $38.00$99.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
COUMADIN 10MG TABLET   3 Preferred Brand $38.00$99.00None
COUMADIN 2.5 MG TABLET   3 Preferred Brand $38.00$99.00None
COUMADIN 2MG TABLET   3 Preferred Brand $38.00$99.00None
COUMADIN 3mg/1 1 BOTTLE per CARTON / 100 TABLET BOTTLE   3 Preferred Brand $38.00$99.00None
COUMADIN 4mg/1 1 BOTTLE in 1 CARTON / 100 TABLET BOTTLE   3 Preferred Brand $38.00$99.00None
COUMADIN 5MG TABLET   3 Preferred Brand $38.00$99.00None
COUMADIN 6MG TABLET   3 Preferred Brand $38.00$99.00None
COUMADIN 7.5MG TABLET   3 Preferred Brand $38.00$99.00None
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE   3 Preferred Brand $38.00$99.00None
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT   3 Preferred Brand $38.00$99.00None
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT   3 Preferred Brand $38.00$99.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT   3 Preferred Brand $38.00$99.00None
CREON DR 36,000 UNITS CAPSULE   3 Preferred Brand $38.00$99.00None
CRINONE 4% GEL   4 Non-Preferred Drug 38%38%P
CRINONE 8% GEL   4 Non-Preferred Drug 38%38%P
CRIXIVAN 200MG CAPSULE   3 Preferred Brand $38.00$99.00Q:270
/30Days
CRIXIVAN 400mg, 180 CAPSULE BOTTLE   3 Preferred Brand $38.00$99.00Q:270
/30Days
CROMOLYN 20 MG/2 ML NEB SOLN   3 Preferred Brand $38.00$99.00P
CROMOLYN SODIUM 100 MG/5 ML   4 Non-Preferred Drug 38%38%None
CROMOLYN SODIUM 4% 40MG 10ML BOT   2 Generic $12.00$0.00None
CUVPOSA 1 MG/5 ML SOLUTION   4 Non-Preferred Drug 38%38%None
Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK   4 Non-Preferred Drug 38%38%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYCLAFEM 7-7-7-28 TABLET   4 Non-Preferred Drug 38%38%None
CYCLOBENZAPRINE 10 MG TABLET   2 Generic $12.00$0.00None
CYCLOBENZAPRINE 5 MG TABLET   2 Generic $12.00$0.00None
CYCLOPHOSPHAMIDE 25 MG CAPSULE   4 Non-Preferred Drug 38%38%P
CYCLOPHOSPHAMIDE 50 MG CAPSULE   4 Non-Preferred Drug 38%38%P
CYCLOSET 0.8MG TABLETS   4 Non-Preferred Drug 38%38%P Q:180
/30Days
CYCLOSPORINE 100MG CAPSULE   3 Preferred Brand $38.00$99.00P
CYCLOSPORINE 25MG CAPSULE   3 Preferred Brand $38.00$99.00P
Cyclosporine 50 mg/ml vial   4 Non-Preferred Drug 38%38%None
CYCLOSPORINE MODIFIED 100 MG   3 Preferred Brand $38.00$99.00P
CYCLOSPORINE MODIFIED 25 MG   3 Preferred Brand $38.00$99.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYCLOSPORINE MODIFIED 50 MG   3 Preferred Brand $38.00$99.00P
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT   3 Preferred Brand $38.00$99.00P
CYPROHEPTADINE 4 MG TABLET   3 Preferred Brand $38.00$99.00None
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL   3 Preferred Brand $38.00$99.00None
CYRAMZA 100 MG/10 ML VIAL   5 Specialty Tier 33%33%P
CYRAMZA 500 MG/50 ML VIAL   5 Specialty Tier 33%33%P
CYSTADANE 1 GRAM/1.7 ML POWDER   5 Specialty Tier 33%33%None
CYSTAGON 150MG CAPSULE   4 Non-Preferred Drug 38%38%None
CYSTAGON 50MG CAPSULE   4 Non-Preferred Drug 38%38%None
CYSTARAN 0.44% EYE DROPS   5 Specialty Tier 33%33%None
CYTARABINE 20MG/ML VIAL   4 Non-Preferred Drug 38%38%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD   4 Non-Preferred Drug 38%38%P

Chart Legend:

Below are a few notes to help you understand the above 2018 Medicare Part D AARP MedicareRx Preferred (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $405 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs. *Some Part D plans exclude one or more drug tiers from the deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3750) at a "Preferred" network pharmacy. In most cases, the "Preferred" network network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2018 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.