2019 Medicare Part D Plan Formulary Information |
AARP MedicareRx Walgreens (PDP) (S5921-393-0)
Benefit Details
 |
The AARP MedicareRx Walgreens (PDP) (S5921-393-0) Formulary Drugs Starting with the Letter N in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $28.10 Deductible: $415 Qualifies for LIS: No |
Drugs Starting with Letter N
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Nafcillin 1 gm vial  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NAFCILLIN 10 GM BULK VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NAFCILLIN 2 GM VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NALOXONE 0.4 MG/ML CARPUJECT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NALOXONE 0.4 MG/ML VIAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
naloxone 1 mg/ml syringe  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NALTREXONE 50 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Naproxen 125 mg/5 ml suspen  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NAPROXEN 250 MG ORAL TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NAPROXEN 375 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NAPROXEN 500 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NAPROXEN DR 375 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NAPROXEN DR 500 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NARATRIPTAN HCL 1 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:12 /30Days |
NARATRIPTAN HCL 2.5 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:12 /30Days |
NARCAN 4 MG NASAL SPRAY  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NATACYN EYE DROPS  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NATPARA 100 MCG DOSE CARTRIDGE  |
5 |
Specialty Tier |
25% | 25% | P |
NATPARA 25 MCG DOSE CARTRIDGE  |
5 |
Specialty Tier |
25% | 25% | P |
NATPARA 50 MCG DOSE CARTRIDGE  |
5 |
Specialty Tier |
25% | 25% | P |
NATPARA 75 MCG DOSE CARTRIDGE  |
5 |
Specialty Tier |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEBUPENT 300MG INHAL POWDER  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:1 /28Days |
NECON 0.5-35-28 TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEFAZODONE HCL 150MG TABLET (60 CT)  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEFAZODONE HCL 250MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEFAZODONE HCL 50MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEOMYC-POLYM-DEXAMET EYE OINTM [Poly-Dex] ![Compare how all Medicare Part D PDP plans in AL cover NEOMYC-POLYM-DEXAMET EYE OINTM [Poly-Dex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
NEOMYC-POLYM-DEXAMETH EYE DROP  |
2* |
Generic |
$5.00 | $15.00 | None |
NEOMYCIN SULFATE 500MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEOMYCIN/POLYMY/HYDRO OTIC SUS  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEPHRAMINE SOLUTION FOR INJECTION  |
4 |
Non-Preferred Drug |
32% | 32% | P |
NERLYNX 40 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:180 /30Days |
NEULASTA 6MG/0.6ML SYRINGE  |
5 |
Specialty Tier |
25% | 25% | P |
NEUPRO 1 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEUPRO 2 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEUPRO 3 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEUPRO 4 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEUPRO 6 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEUPRO 8 MG/24 HR PATCH  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NEVANAC 0.1% DROPTAINER  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEVIRAPINE 200 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:90 /30Days |
NEVIRAPINE 50 MG/5 ML SUSP Oral Suspension [Viramune] ![Compare how all Medicare Part D PDP plans in AL cover NEVIRAPINE 50 MG/5 ML SUSP Oral Suspension [Viramune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | Q:1800 /30Days |
NEVIRAPINE ER 100 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | Q:90 /30Days |
NEVIRAPINE ER 400 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | Q:60 /30Days |
NEXAVAR TABLETS 200MG 120 BOT  |
5 |
Specialty Tier |
25% | 25% | P |
NEXIUM 10mg/1 30 GRANULE, DELAYED RELEASE per CARTON  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEXIUM DR 2.5 MG PACKET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NEXIUM DR 20 MG CAPSULE  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:90 /30Days |
NEXIUM DR 40 MG CAPSULE  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:60 /30Days |
NEXIUM DR 5 MG PACKET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NIACIN ER 1,000 MG TABLET [Niaspan ER] ![Compare how all Medicare Part D PDP plans in AL cover NIACIN ER 1,000 MG TABLET [Niaspan ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NIACIN ER 500 MG TABLET [Niaspan ER] ![Compare how all Medicare Part D PDP plans in AL cover NIACIN ER 500 MG TABLET [Niaspan ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NIACIN ER 750 MG TABLET [Niaspan ER] ![Compare how all Medicare Part D PDP plans in AL cover NIACIN ER 750 MG TABLET [Niaspan ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NIACOR 500 MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NIKKI 3 MG-0.02 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NILUTAMIDE 150 MG TABLET [Nilandron] ![Compare how all Medicare Part D PDP plans in AL cover NILUTAMIDE 150 MG TABLET [Nilandron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
NIMODIPINE 30 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NINLARO 2.3 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:3 /28Days |
NINLARO 3 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:3 /28Days |
NINLARO 4 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:3 /28Days |
NITRO-BID 2% OINTMENT  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Nitrofurantoin 25mg/5mL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NITROFURANTOIN MACROCRYSTALLINE 50 mg cap  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROFURANTOIN MCR 100 MG CAPSULE [Macrodantin] ![Compare how all Medicare Part D PDP plans in AL cover NITROFURANTOIN MCR 100 MG CAPSULE [Macrodantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid] ![Compare how all Medicare Part D PDP plans in AL cover NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROGLYCERIN 0.2 MG/HR PATCH  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NITROGLYCERIN 0.3 MG TABLET SL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROGLYCERIN 0.4 MG TABLET SL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROGLYCERIN 0.4 MG/HR PATCH  |
2* |
Generic |
$5.00 | $15.00 | None |
NITROGLYCERIN 0.6 MG TABLET SL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROGLYCERIN 0.6 MG/HR PATCH  |
2* |
Generic |
$5.00 | $15.00 | None |
NITROGLYCERIN LINGUAL 0.4 MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX  |
2* |
Generic |
$5.00 | $15.00 | None |
NITROSTAT 0.3MG TABLET SL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROSTAT 0.4 MG TABLET SL [Nitrotab] ![Compare how all Medicare Part D PDP plans in AL cover NITROSTAT 0.4 MG TABLET SL [Nitrotab].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NITROSTAT 0.6MG TABLET SL  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NORA-BE 0.35MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NORETH-ESTRAD-FE 1-0.02(24)-75 Chewable TABLET [Minastrin] ![Compare how all Medicare Part D PDP plans in AL cover NORETH-ESTRAD-FE 1-0.02(24)-75 Chewable TABLET [Minastrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
32% | 32% | None |
Norethin-Estrad-Ferr 1-0.02 mg  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORETHIND-ETH ESTRAD 1-0.02 MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORETHINDRONE 0.35 MG TABLET  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NORETHINDRONE 5MG TABLET  |
2* |
Generic |
$5.00 | $15.00 | None |
NORG-EE 0.18-0.215-0.25/0.035  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORG-ETHIN ESTRA 0.18-0.215-0.25/0.025  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORG-ETHIN ESTRA 0.25-0.035 MG  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Norlyroc 0.35 mg tablet  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
NORMOSOL -R INJ /D5W  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORMOSOL-M AND DEXTROSE 5%  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NORMOSOL-R PH 7.4 IV SOLUTION  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORTHERA 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:90 /30Days |
NORTHERA 200 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:180 /30Days |
NORTHERA 300 MG CAPSULE  |
4 |
Non-Preferred Drug |
32% | 32% | P Q:180 /30Days |
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK per CARTON / 21 TABLET per BLISTER PACK  |
4 |
Non-Preferred Drug |
32% | 32% | None |
Nortrel (28 Day Regimen) 3 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORTREL 1-0.035MG TABLET 28DAY  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NORTRIPTYLINE 10 MG/5 ML SOL  |
2* |
Generic |
$5.00 | $15.00 | None |
NORTRIPTYLINE HCL 25MG CAP  |
2* |
Generic |
$5.00 | $15.00 | None |
NORTRIPTYLINE HCL 50 MG CAP  |
2* |
Generic |
$5.00 | $15.00 | None |
NORTRIPTYLINE HCL 75 MG CAP  |
2* |
Generic |
$5.00 | $15.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE BOTTLE  |
2* |
Generic |
$5.00 | $15.00 | None |
NORVIR 100 MG POWDER PACKET  |
4 |
Non-Preferred Drug |
32% | 32% | Q:540 /30Days |
NORVIR 100 MG TABLET  |
4 |
Non-Preferred Drug |
32% | 32% | Q:540 /30Days |
NORVIR 80MG/ML ORAL SOLUTION  |
4 |
Non-Preferred Drug |
32% | 32% | Q:720 /30Days |
NOXAFIL 200MG/5ML SUSPENSION ORAL  |
5 |
Specialty Tier |
25% | 25% | Q:600 /30Days |
NOXAFIL DR 100 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:240 /30Days |
NUCALA 100 MG VIAL  |
5 |
Specialty Tier |
25% | 25% | P Q:3 /28Days |
NUEDEXTA 20; 10mg/1; mg/1  |
4 |
Non-Preferred Drug |
32% | 32% | P |
NUPLAZID 10 MG TABLET  |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
NUPLAZID 34 MG CAPSULE  |
5 |
Specialty Tier |
25% | 25% | P Q:30 /30Days |
NUTRILIPID 20 % EMULSION  |
4 |
Non-Preferred Drug |
32% | 32% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NUVARING 0.12-0.015 RING VAGINAL  |
4 |
Non-Preferred Drug |
32% | 32% | None |
NYAMYC 100,000 UNITS/GM POWDER  |
2* |
Generic |
$5.00 | $15.00 | None |
NYMALIZE 30 MG/10 ML SOLUTION  |
5 |
Specialty Tier |
25% | 25% | None |
NYSTATIN 100,000 UNIT/GM CREAM (g) [Pediaderm AF] ![Compare how all Medicare Part D PDP plans in AL cover NYSTATIN 100,000 UNIT/GM CREAM (g) [Pediaderm AF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
NYSTATIN 100,000 UNIT/GM POWD  |
2* |
Generic |
$5.00 | $15.00 | None |
NYSTATIN 100,000 UNITS/GM OINT  |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
Nystatin 100000[USP'U]/mL ![Compare how all Medicare Part D PDP plans in AL cover Nystatin 100000[USP'U]/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $15.00 | None |
NYSTATIN 500,000 UNIT ORAL TAB  |
2* |
Generic |
$5.00 | $15.00 | None |
NYSTOP 100,000 UNITS/GM POWDER  |
2* |
Generic |
$5.00 | $15.00 | None |