2019 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Value Plus (PDP) (S5768-135-0)
Benefit Details
 |
The Aetna Medicare Rx Value Plus (PDP) (S5768-135-0) Formulary Drugs Starting with the Letter R in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $58.70 Deductible: $0 Qualifies for LIS: No |
Drugs Starting with Letter R
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
RABAVERT RABIES VACCINE VIAL  |
3 |
Preferred Brand |
$47.00 | $141.00 | P |
RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex] ![Compare how all Medicare Part D PDP plans in AL cover RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | None |
RALOXIFENE HCL 60 MG TABLET [Evista] ![Compare how all Medicare Part D PDP plans in AL cover RALOXIFENE HCL 60 MG TABLET [Evista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RAMIPRIL 1.25 MG CAPSULE  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RAMIPRIL 10 MG CAPSULE  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RAMIPRIL 2.5 MG CAPSULE  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RAMIPRIL 5 MG CAPSULE  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RANEXA ER 1,000 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RANEXA ER 500 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RANITIDINE 15 MG/ML SYRUP  |
2 |
Generic |
$2.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RANITIDINE 150 MG CAPSULE  |
2 |
Generic |
$2.00 | $6.00 | None |
RANITIDINE 150 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RANITIDINE 300 MG CAPSULE  |
2 |
Generic |
$2.00 | $6.00 | None |
RANITIDINE 300 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
RANOLAZINE ER 1,000 MG TABLET ER 12H [Ranexa] ![Compare how all Medicare Part D PDP plans in AL cover RANOLAZINE ER 1,000 MG TABLET ER 12H [Ranexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RANOLAZINE ER 500 MG TABLET ER 12H [Ranexa] ![Compare how all Medicare Part D PDP plans in AL cover RANOLAZINE ER 500 MG TABLET ER 12H [Ranexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RAPAFLO 4 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RAPAFLO 8 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RAPAMUNE 1MG/ML ORAL TUBEX  |
5 |
Specialty Tier |
33% | N/A | P |
Rasagiline Mesylate 0.5 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in AL cover Rasagiline Mesylate 0.5 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
Rasagiline Mesylate 1 MG TABLET [Azilect] ![Compare how all Medicare Part D PDP plans in AL cover Rasagiline Mesylate 1 MG TABLET [Azilect].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RAYALDEE ER 30 MCG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
REBETOL 40MG/ML SOLUTION  |
5 |
Specialty Tier |
33% | N/A | None |
REBIF 22ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS  |
5 |
Specialty Tier |
33% | N/A | P Q:6 /28Days |
REBIF 44ug/0.5mL 12 SYRINGE, GLASS per CARTON / 0.5 mL in 1 SYRINGE, GLASS  |
5 |
Specialty Tier |
33% | N/A | P Q:6 /28Days |
REBIF REBIDOSE 22 MCG/0.5 ML  |
5 |
Specialty Tier |
33% | N/A | P Q:6 /28Days |
REBIF REBIDOSE 44 MCG/0.5 ML  |
5 |
Specialty Tier |
33% | N/A | P Q:6 /28Days |
REBIF REBIDOSE TITRATION PACK  |
5 |
Specialty Tier |
33% | N/A | P Q:8 /365Days |
REBIF TITRTN SOL PACK 8.8MCG/22 VIAL  |
5 |
Specialty Tier |
33% | N/A | P Q:8 /365Days |
RECLIPSEN 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in AL cover RECLIPSEN 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RECOMBIVAX HB 10 MCG/ML SYR  |
3 |
Preferred Brand |
$47.00 | $141.00 | P |
RECOMBIVAX HB 40MCG/ML VIAL  |
3 |
Preferred Brand |
$47.00 | $141.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REGRANEX 0.01% GEL  |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
RELENZA 5MG DISKHALER  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /365Days |
RELISTOR 12 MG/0.6 ML SYRINGE  |
5 |
Specialty Tier |
33% | N/A | P |
RELISTOR 12 MG/0.6 ML VIAL  |
5 |
Specialty Tier |
33% | N/A | P |
RELISTOR 8 MG/0.4 ML SYRINGE  |
5 |
Specialty Tier |
33% | N/A | P |
RENAGEL 800MG TABLET  |
5 |
Specialty Tier |
33% | N/A | S |
REPAGLINIDE 0.5 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in AL cover REPAGLINIDE 0.5 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$2.00 | $6.00 | Q:120 /30Days |
REPAGLINIDE 1 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in AL cover REPAGLINIDE 1 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$2.00 | $6.00 | Q:120 /30Days |
REPAGLINIDE 2 MG TABLET [Prandin] ![Compare how all Medicare Part D PDP plans in AL cover REPAGLINIDE 2 MG TABLET [Prandin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$2.00 | $6.00 | Q:240 /30Days |
REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in AL cover REPAGLINIDE-METFORMIN 1-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$2.00 | $6.00 | Q:150 /30Days |
REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet] ![Compare how all Medicare Part D PDP plans in AL cover REPAGLINIDE-METFORMIN 2-500 MG [PrandiMet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$2.00 | $6.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RESCRIPTOR 200 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | None |
RESTASIS 0.05% EYE EMULSION  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days |
REVLIMID 10 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REVLIMID 15MG CAPSULE 21 BOT  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REVLIMID 2.5 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REVLIMID 20 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REVLIMID 25 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REVLIMID 5 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
REXULTI 0.25 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:360 /30Days |
REXULTI 0.5 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:180 /30Days |
REXULTI 1 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
REXULTI 2 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:60 /30Days |
REXULTI 3 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
REXULTI 4 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
REYATAZ 150MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
REYATAZ 200MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
REYATAZ 300MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
REYATAZ 50 MG POWDER PACKET  |
5 |
Specialty Tier |
33% | N/A | None |
RIBASPHERE 200 MG CAPSULE  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIBASPHERE 600MG TABLET  |
5 |
Specialty Tier |
33% | N/A | None |
RIBASPHERE RibaPak  |
5 |
Specialty Tier |
33% | N/A | None |
RIBASPHERE RibaPak 600mg/1  |
5 |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIBAVIRIN 200 MG CAPSULE  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIBAVIRIN 200MG TABLET 168 BOT  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIDAURA 3 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | None |
RIFABUTIN 150 MG CAPSULE [Mycobutin] ![Compare how all Medicare Part D PDP plans in AL cover RIFABUTIN 150 MG CAPSULE [Mycobutin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | None |
RIFAMPIN 150 MG CAPSULE  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIFAMPIN 300 MG CAPSULE  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIFAMPIN IV 600 MG VIAL  |
4 |
Non-Preferred Drug |
45% | 45% | None |
RIFATER 50/300/120 TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | None |
RILUZOLE 50 MG TABLET [Rilutek] ![Compare how all Medicare Part D PDP plans in AL cover RILUZOLE 50 MG TABLET [Rilutek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | None |
Rimantadine 100mg/1 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
45% | 45% | None |
RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISEDRONATE SODIUM 150 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 150 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:1 /28Days |
RISEDRONATE SODIUM 30 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 30 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RISEDRONATE SODIUM 35 MG TAB [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 35 MG TAB [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:12 /84Days |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:12 /84Days |
RISEDRONATE SODIUM 35 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 35 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:12 /84Days |
RISEDRONATE SODIUM 5 MG TABLET [Actonel] ![Compare how all Medicare Part D PDP plans in AL cover RISEDRONATE SODIUM 5 MG TABLET [Actonel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RISPERDAL CONSTA 25MG SYR  |
4 |
Non-Preferred Drug |
45% | 45% | Q:2 /28Days |
RISPERDAL CONSTA 37.5MG SYR  |
5 |
Specialty Tier |
33% | N/A | Q:2 /28Days |
RISPERDAL CONSTA 50MG SYR  |
5 |
Specialty Tier |
33% | N/A | Q:2 /28Days |
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL  |
4 |
Non-Preferred Drug |
45% | 45% | Q:2 /28Days |
RISPERIDONE 0.25 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE 0.5 MG ODT  |
4 |
Non-Preferred Drug |
45% | 45% | Q:90 /30Days |
RISPERIDONE 0.5 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days |
RISPERIDONE 1 MG ODT  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RISPERIDONE 1 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days |
RISPERIDONE 1 MG/ML SOLUTION  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RISPERIDONE 2 MG ODT  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RISPERIDONE 2 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days |
RISPERIDONE 3 MG ODT  |
4 |
Non-Preferred Drug |
45% | 45% | Q:90 /30Days |
RISPERIDONE 3 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days |
RISPERIDONE 4 MG ODT  |
4 |
Non-Preferred Drug |
45% | 45% | Q:120 /30Days |
RISPERIDONE 4 MG TABLET  |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK  |
4 |
Non-Preferred Drug |
45% | 45% | Q:90 /30Days |
RITONAVIR 100 MG TABLET [Norvir] ![Compare how all Medicare Part D PDP plans in AL cover RITONAVIR 100 MG TABLET [Norvir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIVASTIGMINE 1.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RIVASTIGMINE 13.3 MG/24HR PTCH  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RIVASTIGMINE 3 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RIVASTIGMINE 4.5 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RIVASTIGMINE 4.6 MG/24HR PATCH  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RIVASTIGMINE 6 MG CAPSULE  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
RIVASTIGMINE 9.5 MG/24HR PATCH  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
RIVELSA TABLET TBDSPK 3MO  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
RIZATRIPTAN 10 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in AL cover RIZATRIPTAN 10 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:12 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
RIZATRIPTAN 10 MG TABLET [Maxalt] ![Compare how all Medicare Part D PDP plans in AL cover RIZATRIPTAN 10 MG TABLET [Maxalt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:12 /30Days |
RIZATRIPTAN 5 MG ODT [Maxalt-MLT] ![Compare how all Medicare Part D PDP plans in AL cover RIZATRIPTAN 5 MG ODT [Maxalt-MLT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:12 /30Days |
RIZATRIPTAN 5 MG TABLET [Maxalt] ![Compare how all Medicare Part D PDP plans in AL cover RIZATRIPTAN 5 MG TABLET [Maxalt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:12 /30Days |
ROPINIROLE HCL 0.25 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 0.5 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 1 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 2 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 3 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 4 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL 5 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
ROPINIROLE HCL ER 12 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROPINIROLE HCL ER 2 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days |
ROPINIROLE HCL ER 4 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | Q:150 /30Days |
ROPINIROLE HCL ER 6 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | Q:120 /30Days |
ROPINIROLE HCL ER 8 MG TABLET  |
4 |
Non-Preferred Drug |
45% | 45% | Q:90 /30Days |
ROSUVASTATIN CALCIUM 10 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in AL cover ROSUVASTATIN CALCIUM 10 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
ROSUVASTATIN CALCIUM 20 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in AL cover ROSUVASTATIN CALCIUM 20 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor] ![Compare how all Medicare Part D PDP plans in AL cover Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
ROSUVASTATIN CALCIUM 5 MG TAB [Crestor] ![Compare how all Medicare Part D PDP plans in AL cover ROSUVASTATIN CALCIUM 5 MG TAB [Crestor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days |
ROTARIX VACCINE SUSPENSION  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
ROTATEQ VACCINE Solution  |
3 |
Preferred Brand |
$47.00 | $141.00 | None |
Roweepra 1,000 mg tablet  |
2 |
Generic |
$2.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ROWEEPRA 500 MG TABLET  |
2 |
Generic |
$2.00 | $6.00 | None |
Roweepra 750 mg tablet  |
2 |
Generic |
$2.00 | $6.00 | None |
ROWEEPRA XR 500 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
45% | 45% | None |
ROWEEPRA XR 750 MG TABLET ER 24H  |
4 |
Non-Preferred Drug |
45% | 45% | None |
RUBRACA 200 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P |
RUBRACA 250 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P |
RUBRACA 300 MG TABLET  |
5 |
Specialty Tier |
33% | N/A | P |
RYDAPT 25 MG CAPSULE  |
5 |
Specialty Tier |
33% | N/A | P |