2019 Medicare Part D Plan Formulary Information |
SelectHealth Advantage (HMO) (H1994-002-0)
Benefit Details
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The SelectHealth Advantage (HMO) (H1994-002-0) Formulary Drugs Starting with the Letter R in Sevier County, UT: CMS MA Region 23 which includes: UT Plan Monthly Premium: $74.00 Deductible: $250 |
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 ![Compare how all Medicare Part D PDP plans in UT cover RABAVERT RABIES VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex] ![Compare how all Medicare Part D PDP plans in UT cover RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
RALOXIFENE HCL 60 MG TABLET [Evista] ![Compare how all Medicare Part D PDP plans in UT cover RALOXIFENE HCL 60 MG TABLET [Evista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
RAMIPRIL 1.25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RAMIPRIL 1.25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
RAMIPRIL 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RAMIPRIL 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
RAMIPRIL 2.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RAMIPRIL 2.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
RAMIPRIL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RAMIPRIL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
RANITIDINE 15 MG/ML SYRUP ![Compare how all Medicare Part D PDP plans in UT cover RANITIDINE 15 MG/ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
RANITIDINE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RANITIDINE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
RANITIDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RANITIDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RANITIDINE 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RANITIDINE 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
RANITIDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RANITIDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
RANOLAZINE ER 1,000 MG TABLET ER 12H [Ranexa] ![Compare how all Medicare Part D PDP plans in UT cover RANOLAZINE ER 1,000 MG TABLET ER 12H [Ranexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:120 /30Days |
RANOLAZINE ER 500 MG TABLET ER 12H [Ranexa] ![Compare how all Medicare Part D PDP plans in UT cover RANOLAZINE ER 500 MG TABLET ER 12H [Ranexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:120 /30Days |
Rasagiline Mesylate 0.5 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in UT cover Rasagiline Mesylate 0.5 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
Rasagiline Mesylate 1 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in UT cover Rasagiline Mesylate 1 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RASUVO 10 MG/0.2 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 10 MG/0.2 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:1 /28Days |
RASUVO 12.5 MG/0.25 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 12.5 MG/0.25 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:1 /28Days |
RASUVO 15 MG/0.3 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 15 MG/0.3 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:1 /28Days |
RASUVO 17.5 MG/0.35 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 17.5 MG/0.35 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:1 /28Days |
RASUVO 20 MG/0.4 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 20 MG/0.4 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RASUVO 22.5 MG/0.45 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 22.5 MG/0.45 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:2 /28Days |
RASUVO 25 MG/0.5 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 25 MG/0.5 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:2 /28Days |
RASUVO 30 MG/0.6 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 30 MG/0.6 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:2 /28Days |
RASUVO 7.5 MG/0.15 ML AUTOINJ ![Compare how all Medicare Part D PDP plans in UT cover RASUVO 7.5 MG/0.15 ML AUTOINJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | S Q:1 /28Days |
RAVICTI 1.1 GRAM/ML LIQUID ![Compare how all Medicare Part D PDP plans in UT cover RAVICTI 1.1 GRAM/ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P Q:525 /30Days |
REBETOL 40MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover REBETOL 40MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | 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 UT 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 |
28% | N/A | P Q:12 /28Days |
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 UT 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 |
28% | N/A | P Q:12 /28Days |
REBIF REBIDOSE 22 MCG/0.5 ML ![Compare how all Medicare Part D PDP plans in UT cover REBIF REBIDOSE 22 MCG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:12 /28Days |
REBIF REBIDOSE 44 MCG/0.5 ML ![Compare how all Medicare Part D PDP plans in UT cover REBIF REBIDOSE 44 MCG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:12 /28Days |
REBIF REBIDOSE TITRATION PACK ![Compare how all Medicare Part D PDP plans in UT cover REBIF REBIDOSE TITRATION PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:12 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL ![Compare how all Medicare Part D PDP plans in UT cover REBIF TITRTN SOL PACK 8.8MCG/22 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:12 /28Days |
RECLIPSEN 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in UT cover RECLIPSEN 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RECOMBIVAX HB 10 MCG/ML SYR ![Compare how all Medicare Part D PDP plans in UT cover RECOMBIVAX HB 10 MCG/ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
RECOMBIVAX HB 40MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RECOMBIVAX HB 40MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
RELENZA 5MG DISKHALER ![Compare how all Medicare Part D PDP plans in UT cover RELENZA 5MG DISKHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:60 /30Days |
RELISTOR 12 MG/0.6 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover RELISTOR 12 MG/0.6 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:17 /28Days |
RELISTOR 12 MG/0.6 ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RELISTOR 12 MG/0.6 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:17 /28Days |
RELISTOR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RELISTOR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:90 /30Days |
RELISTOR 8 MG/0.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover RELISTOR 8 MG/0.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:22 /28Days |
REPAGLINIDE 0.5 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in UT cover REPAGLINIDE 0.5 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
REPAGLINIDE 1 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in UT cover REPAGLINIDE 1 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | 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 UT cover REPAGLINIDE 2 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in UT cover REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in UT cover REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
REPATHA 140 MG/ML SURECLICK ![Compare how all Medicare Part D PDP plans in UT cover REPATHA 140 MG/ML SURECLICK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:3 /30Days |
REPATHA 140 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in UT cover REPATHA 140 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:3 /30Days |
REPATHA 420 MG/3.5ML PUSHTRONX ![Compare how all Medicare Part D PDP plans in UT cover REPATHA 420 MG/3.5ML PUSHTRONX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /30Days |
RESCRIPTOR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RESCRIPTOR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:180 /30Days |
RESTASIS 0.05% EYE EMULSION ![Compare how all Medicare Part D PDP plans in UT cover RESTASIS 0.05% EYE EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:60 /30Days |
RETACRIT 10,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RETACRIT 10,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
RETACRIT 2,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RETACRIT 2,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
RETACRIT 3,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RETACRIT 3,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RETACRIT 4,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RETACRIT 4,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
RETACRIT 40,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in UT cover RETACRIT 40,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | P |
REVATIO 10 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in UT cover REVATIO 10 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:180 /30Days |
REVLIMID 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REVLIMID 15MG CAPSULE 21 BOT ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 15MG CAPSULE 21 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REVLIMID 2.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 2.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REVLIMID 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REVLIMID 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REVLIMID 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover REVLIMID 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
REXULTI 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
REXULTI 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REXULTI 1 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
REXULTI 2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
REXULTI 3 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
REXULTI 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover REXULTI 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days |
REYATAZ 50 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in UT cover REYATAZ 50 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:240 /30Days |
RHOFADE 1% CREAM (g) ![Compare how all Medicare Part D PDP plans in UT cover RHOFADE 1% CREAM (g).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:150 /365Days |
RHOPRESSA 0.02% OPHTH SOLUTION Drops ![Compare how all Medicare Part D PDP plans in UT cover RHOPRESSA 0.02% OPHTH SOLUTION Drops.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days |
RIBASPHERE 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIBASPHERE 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:210 /30Days |
RIBAVIRIN 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIBAVIRIN 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:210 /30Days |
RIBAVIRIN 200MG TABLET 168 BOT ![Compare how all Medicare Part D PDP plans in UT cover RIBAVIRIN 200MG TABLET 168 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:210 /30Days |
RIDAURA 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIDAURA 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIFABUTIN 150 MG CAPSULE [Mycobutin] ![Compare how all Medicare Part D PDP plans in UT cover RIFABUTIN 150 MG CAPSULE [Mycobutin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIFAMPIN 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIFAMPIN 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIFAMPIN 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIFAMPIN 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIFAMPIN IV 600 MG VIAL ![Compare how all Medicare Part D PDP plans in UT cover RIFAMPIN IV 600 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIFATER 50/300/120 TABLET ![Compare how all Medicare Part D PDP plans in UT cover RIFATER 50/300/120 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
RILUZOLE 50 MG TABLET [Rilutek] ![Compare how all Medicare Part D PDP plans in UT cover RILUZOLE 50 MG TABLET [Rilutek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:4 /28Days |
RISEDRONATE SODIUM 150 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 150 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:1 /28Days |
RISEDRONATE SODIUM 30 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 30 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:30 /30Days |
RISEDRONATE SODIUM 35 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 35 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:4 /28Days |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:12 /84Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:4 /28Days |
RISEDRONATE SODIUM 5 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in UT cover RISEDRONATE SODIUM 5 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | S Q:30 /30Days |
RISPERDAL CONSTA 25MG SYR ![Compare how all Medicare Part D PDP plans in UT cover RISPERDAL CONSTA 25MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
RISPERDAL CONSTA 37.5MG SYR ![Compare how all Medicare Part D PDP plans in UT cover RISPERDAL CONSTA 37.5MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
RISPERDAL CONSTA 50MG SYR ![Compare how all Medicare Part D PDP plans in UT cover RISPERDAL CONSTA 50MG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL ![Compare how all Medicare Part D PDP plans in UT 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 | $285.00 | None |
RISPERIDONE 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
RISPERIDONE 0.5 MG ODT ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 0.5 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
RISPERIDONE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
RISPERIDONE 1 MG ODT ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 1 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
RISPERIDONE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:240 /30Days |
RISPERIDONE 2 MG ODT ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 2 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
RISPERIDONE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
RISPERIDONE 3 MG ODT ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 3 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
RISPERIDONE 3 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
RISPERIDONE 4 MG ODT ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 4 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:60 /30Days |
RISPERIDONE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK ![Compare how all Medicare Part D PDP plans in UT cover RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:30 /30Days |
RITONAVIR 100 MG TABLET [Norvir] ![Compare how all Medicare Part D PDP plans in UT cover RITONAVIR 100 MG TABLET [Norvir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:450 /30Days |
RIVASTIGMINE 1.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 1.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIVASTIGMINE 13.3 MG/24HR PTCH ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 13.3 MG/24HR PTCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIVASTIGMINE 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIVASTIGMINE 4.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 4.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIVASTIGMINE 4.6 MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 4.6 MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIVASTIGMINE 6 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 6 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIVASTIGMINE 9.5 MG/24HR PATCH ![Compare how all Medicare Part D PDP plans in UT cover RIVASTIGMINE 9.5 MG/24HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | None |
RIZATRIPTAN 10 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in UT cover RIZATRIPTAN 10 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:18 /30Days |
RIZATRIPTAN 10 MG TABLET [Maxalt] ![Compare how all Medicare Part D PDP plans in UT cover RIZATRIPTAN 10 MG TABLET [Maxalt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:18 /30Days |
RIZATRIPTAN 5 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in UT cover RIZATRIPTAN 5 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:18 /30Days |
RIZATRIPTAN 5 MG TABLET [Maxalt] ![Compare how all Medicare Part D PDP plans in UT cover RIZATRIPTAN 5 MG TABLET [Maxalt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:18 /30Days |
ROCKLATAN 0.02%-0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in UT cover ROCKLATAN 0.02%-0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:5 /30Days |
ROPINIROLE HCL 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL 2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL 3 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | None |
ROPINIROLE HCL ER 12 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL ER 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:90 /30Days |
ROPINIROLE HCL ER 2 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL ER 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:90 /30Days |
ROPINIROLE HCL ER 4 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL ER 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:90 /30Days |
ROPINIROLE HCL ER 6 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL ER 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:90 /30Days |
ROPINIROLE HCL ER 8 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROPINIROLE HCL ER 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$15.00 | $30.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROSUVASTATIN CALCIUM 10 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in UT cover ROSUVASTATIN CALCIUM 10 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ROSUVASTATIN CALCIUM 20 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in UT cover ROSUVASTATIN CALCIUM 20 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor] ![Compare how all Medicare Part D PDP plans in UT cover Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ROSUVASTATIN CALCIUM 5 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in UT cover ROSUVASTATIN CALCIUM 5 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days |
ROTARIX VACCINE SUSPENSION ![Compare how all Medicare Part D PDP plans in UT cover ROTARIX VACCINE SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
ROTATEQ VACCINE Solution ![Compare how all Medicare Part D PDP plans in UT cover ROTATEQ VACCINE Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $135.00 | None |
Rowasa Rectal 4 G 60 ml Kit 28X60 ![Compare how all Medicare Part D PDP plans in UT cover Rowasa Rectal 4 G 60 ml Kit 28X60.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | None |
ROZEREM 8 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover ROZEREM 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days |
RUBRACA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RUBRACA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
RUBRACA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RUBRACA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
RUBRACA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in UT cover RUBRACA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RYDAPT 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in UT cover RYDAPT 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:240 /30Days |
RYTARY ER 23.75 MG-95 MG CAP ![Compare how all Medicare Part D PDP plans in UT cover RYTARY ER 23.75 MG-95 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:300 /30Days |
RYTARY ER 36.25 MG-145 MG CAP ![Compare how all Medicare Part D PDP plans in UT cover RYTARY ER 36.25 MG-145 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:300 /30Days |
RYTARY ER 48.75 MG-195 MG CAP ![Compare how all Medicare Part D PDP plans in UT cover RYTARY ER 48.75 MG-195 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:300 /30Days |
RYTARY ER 61.25 MG-245 MG CAP ![Compare how all Medicare Part D PDP plans in UT cover RYTARY ER 61.25 MG-245 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:300 /30Days |