2019 Medicare Part D Plan Formulary Information |
AARP MedicareRx Preferred (PDP) (S5820-010-0)
Benefit Details
|
The AARP MedicareRx Preferred (PDP) (S5820-010-0) Formulary Drugs Starting with the Letter I in CMS PDP Region 11 which includes: FL Plan Monthly Premium: $76.60 Deductible: $0 Qualifies for LIS: No |
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:1 /28Days |
IBRANCE 100 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IBRANCE 125 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IBRANCE 75 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE |
2 |
Generic |
$10.00 | $0.00 | None |
IBUPROFEN 400 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
IBUPROFEN 600 MG ORAL TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
IBUPROFEN 600mg/1 500 TABLET BOTTLE |
2 |
Generic |
$10.00 | $0.00 | None |
IBUPROFEN 800 MG ORAL TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
IBUPROFEN 800 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ICLUSIG 15 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
ICLUSIG 45 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IDHIFA 100 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IDHIFA 50 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
ILEVRO 0.3% OPHTH DROPS |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
IMATINIB MESYLATE 100 MG TAB [Gleevec] |
5 |
Specialty Tier |
33% | 33% | P Q:90 /30Days |
IMATINIB MESYLATE 400 MG TAB [Gleevec] |
5 |
Specialty Tier |
33% | 33% | P Q:90 /30Days |
IMBRUVICA 140 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
IMBRUVICA 140 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IMBRUVICA 280 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IMBRUVICA 420 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMBRUVICA 560 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IMBRUVICA 70 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
IMIPRAMINE HCL 10MG TABLET (100 CT) |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE HCL 25MG TABLET (100 CT) |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE HCL 50 MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE PAMOATE 100MG CAPSULES |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE PAMOATE 125MG CAPSULES |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE PAMOATE 150MG CAPSULES |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIPRAMINE PAMOATE 75MG CAPSULES |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMIQUIMOD 5% CREAM PACKET |
4 |
Non-Preferred Drug |
40% | 40% | None |
IMOVAX RABIES VACCINE |
3 |
Preferred Brand |
$40.00 | $105.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMVEXXY 10 MCG MAINTENANCE PAK INSERT |
3 |
Preferred Brand |
$40.00 | $105.00 | P Q:30 /30Days |
IMVEXXY 10 MCG STARTER PACK INSR DS PK |
3 |
Preferred Brand |
$40.00 | $105.00 | P Q:30 /30Days |
IMVEXXY 4 MCG MAINTENANCE PACK INSERT |
3 |
Preferred Brand |
$40.00 | $105.00 | P Q:30 /30Days |
IMVEXXY 4 MCG STARTER PACK INSR DS PK |
3 |
Preferred Brand |
$40.00 | $105.00 | P Q:30 /30Days |
INCASSIA 0.35 MG TABLET [Sharobel 28-Day] |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE |
5 |
Specialty Tier |
33% | 33% | P |
INCRUSE ELLIPTA 62.5 MCG INH |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:30 /30Days |
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC |
2 |
Generic |
$10.00 | $0.00 | None |
INDAPAMIDE 2.5 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
INDOMETHACIN 25 MG CAPSULE |
2 |
Generic |
$10.00 | $0.00 | None |
INDOMETHACIN 50 MG CAPSULE |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDOMETHACIN ER 75 MG CAPSULE |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
INFANRIX DTAP VIAL |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
INGREZZA 40 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
INGREZZA 80 MG CAPSULE |
5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days |
INGREZZA INITIATION PACK CAPSULE DS PK |
5 |
Specialty Tier |
33% | 33% | P Q:28 /28Days |
INLYTA 1 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
INLYTA 5 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
INSULIN LISPRO 100 UNIT/ML INSULN PEN [Humalog KwikPen] |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
INSULIN LISPRO 100 UNIT/ML VIAL [Humalog KwikPen] |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
INTELENCE 100MG TABLET |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
Intelence 200mg/1 |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTELENCE 25 MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | Q:180 /30Days |
INTRALIPID 20% IV FAT EMUL EMULSION |
4 |
Non-Preferred Drug |
40% | 40% | P |
INTRALIPID 30% IV FAT EMUL |
4 |
Non-Preferred Drug |
40% | 40% | P |
INTRON A 10 MILLION UNITS VIAL |
5 |
Specialty Tier |
33% | 33% | P |
INTRON A 18 MILLION UNITS VIAL |
5 |
Specialty Tier |
33% | 33% | P |
INTRON A 25 MILLION UNIT/2.5ML VIAL |
5 |
Specialty Tier |
33% | 33% | P |
INTRON A 50 MILLION UNITS VIAL |
5 |
Specialty Tier |
33% | 33% | P |
INTRON A 6MMU/ML VIAL |
5 |
Specialty Tier |
33% | 33% | P |
INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin] |
4 |
Non-Preferred Drug |
40% | 40% | None |
INVANZ 1GM VIAL |
4 |
Non-Preferred Drug |
40% | 40% | None |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe |
5 |
Specialty Tier |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Invega Sustenna 156 mg/mL Prefilled Syringe |
5 |
Specialty Tier |
33% | 33% | None |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe |
5 |
Specialty Tier |
33% | 33% | None |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe |
4 |
Non-Preferred Drug |
40% | 40% | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe |
5 |
Specialty Tier |
33% | 33% | None |
INVEGA TRINZA 273 MG/0.875 ML |
5 |
Specialty Tier |
33% | 33% | None |
INVEGA TRINZA 410 MG/1.315 ML |
5 |
Specialty Tier |
33% | 33% | None |
INVEGA TRINZA 546 MG/1.75 ML |
5 |
Specialty Tier |
33% | 33% | None |
INVEGA TRINZA 819 MG/2.625 ML |
5 |
Specialty Tier |
33% | 33% | None |
INVIRASE 500MG TABLET |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days |
INVOKAMET 150-1,000 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET 150-500 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVOKAMET 50-1,000 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET 50-500 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 150-1,000 MG TAB |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 150-500 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 50-1,000 MG TAB |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 50-500 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:60 /30Days |
INVOKANA 100 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:30 /30Days |
INVOKANA 300 MG TABLET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:30 /30Days |
IONOSOL MB-D5W IV SOLUTION |
4 |
Non-Preferred Drug |
40% | 40% | None |
IPOL VIAL 40;8;32; UNT |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML |
2 |
Generic |
$10.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IPRATROPIUM 0.06% SPRAY |
2 |
Generic |
$10.00 | $0.00 | None |
IPRATROPIUM BR 0.02% SOLN |
2 |
Generic |
$10.00 | $0.00 | P |
IPRATROPIUM BROMIDE NASAL SPRAY |
2 |
Generic |
$10.00 | $0.00 | None |
IRBESARTAN 150 MG TABLET [Avapro] |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
IRBESARTAN 300 MG TABLET [Avapro] |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
IRBESARTAN 75 MG TABLET [Avapro] |
2 |
Generic |
$10.00 | $0.00 | Q:90 /30Days |
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide] |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide] |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days |
IRESSA 250 MG TABLET |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
ISENTRESS 100 MG POWDER PACKET |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:120 /30Days |
ISENTRESS 100 MG TABLET CHEW |
5 |
Specialty Tier |
33% | 33% | Q:270 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISENTRESS 25 MG TABLET CHEW |
3 |
Preferred Brand |
$40.00 | $105.00 | Q:270 /30Days |
ISENTRESS 400MG TABLET |
5 |
Specialty Tier |
33% | 33% | Q:180 /30Days |
ISENTRESS HD 600 MG TABLET |
5 |
Specialty Tier |
33% | 33% | Q:90 /30Days |
ISIBLOOM 28 DAY TABLET [Solia] |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISOLYTE P IN 5% DEXTROSE INJECTION |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISOLYTE S IV SOLUTION-EXCEL |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISONIAZID 100 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISONIAZID 300 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISONIAZID 50MG/5ML SYRUP |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISOSORBIDE DINITRATE 40MG TABLETS ER |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE DN 10 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE DN 20 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE DN 30 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE DN 5 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE MN 10 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE MN ER 30 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE MN ER 60 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) |
2 |
Generic |
$10.00 | $0.00 | None |
ISOTON GENTAMICIN 80MG/100ML |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISOTONIC GENTAMICIN 100 MG/100 ML |
4 |
Non-Preferred Drug |
40% | 40% | None |
ISOTONIC GENTAMICIN 80 MG/50 ML |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOTRETINOIN 10 MG CAPSULE [ZENATANE] |
4 |
Non-Preferred Drug |
40% | 40% | P |
ISOTRETINOIN 20 MG CAPSULE [ZENATANE] |
4 |
Non-Preferred Drug |
40% | 40% | P |
ISOTRETINOIN 30 MG CAPSULE [ZENATANE] |
4 |
Non-Preferred Drug |
40% | 40% | P |
ISOTRETINOIN 40 MG CAPSULE [ZENATANE] |
4 |
Non-Preferred Drug |
40% | 40% | P |
ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox] |
5 |
Specialty Tier |
33% | 33% | P |
ITRACONAZOLE 100 MG CAPSULE [Sporanox] |
4 |
Non-Preferred Drug |
40% | 40% | P Q:120 /30Days |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] |
3 |
Preferred Brand |
$40.00 | $105.00 | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML |
3 |
Preferred Brand |
$40.00 | $105.00 | None |