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BlueRx Enhanced Plus (PDP) (S1030-001-0)
Tier 1 (258)
Tier 2 (1701)
Tier 3 (363)
Tier 4 (1048)
Tier 5 (814)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
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Cick on the first letter of your drug name to browse the formulary:

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2019 Medicare Part D Plan Formulary Information
BlueRx Enhanced Plus (PDP) (S1030-001-0)
Benefit Details           
The BlueRx Enhanced Plus (PDP) (S1030-001-0)
Formulary Drugs Starting with the Letter R

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $119.90 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 $40.00$80.00P
RABEPRAZOLE SOD DR 20 MG TABLET DR [AcipHex]   2 Generic $8.00$16.00Q:30
/30Days
RALOXIFENE HCL 60 MG TABLET [Evista]   2 Generic $8.00$16.00None
RAMIPRIL 1.25 MG CAPSULE   1 Preferred Generic $2.00$4.00None
RAMIPRIL 10 MG CAPSULE   1 Preferred Generic $2.00$4.00None
RAMIPRIL 2.5 MG CAPSULE   1 Preferred Generic $2.00$4.00None
RAMIPRIL 5 MG CAPSULE   1 Preferred Generic $2.00$4.00None
RANEXA ER 1,000 MG TABLET   3 Preferred Brand $40.00$80.00Q:60
/30Days
RANEXA ER 500 MG TABLET   3 Preferred Brand $40.00$80.00Q:60
/30Days
RANITIDINE 15 MG/ML SYRUP   2 Generic $8.00$16.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RANITIDINE 150 MG CAPSULE   2 Generic $8.00$16.00None
RANITIDINE 150 MG TABLET   1 Preferred Generic $2.00$4.00None
RANITIDINE 300 MG CAPSULE   2 Generic $8.00$16.00None
RANITIDINE 300 MG TABLET   1 Preferred Generic $2.00$4.00None
RANOLAZINE ER 1,000 MG TABLET ER 12H [Ranexa]   2 Generic $8.00$16.00Q:60
/30Days
RANOLAZINE ER 500 MG TABLET ER 12H [Ranexa]   2 Generic $8.00$16.00Q:60
/30Days
RAPAFLO 4 MG CAPSULE   3 Preferred Brand $40.00$80.00Q:30
/30Days
RAPAFLO 8 MG CAPSULE   3 Preferred Brand $40.00$80.00Q:30
/30Days
RAPAMUNE 1MG/ML ORAL TUBEX   5 Specialty Tier 33%33%P
Rasagiline Mesylate 0.5 MG TABLET [Azilect]   2 Generic $8.00$16.00None
Rasagiline Mesylate 1 MG TABLET [Azilect]   2 Generic $8.00$16.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RAZADYNE 12MG TABLET   4 Non-Preferred Brand 45%45%None
RAZADYNE 4MG TABLET   4 Non-Preferred Brand 45%45%None
RAZADYNE 8MG TABLET   4 Non-Preferred Brand 45%45%None
RAZADYNE ER 16MG CAPSULE   4 Non-Preferred Brand 45%45%None
RAZADYNE ER 24MG CAPSULE   4 Non-Preferred Brand 45%45%None
RAZADYNE ER 8MG CAPSULE   4 Non-Preferred Brand 45%45%None
REBETOL 40MG/ML SOLUTION   4 Non-Preferred Brand 45%45%None
RECLIPSEN 28 DAY TABLET [Solia]   2 Generic $8.00$16.00None
RECOMBIVAX HB 10 MCG/ML SYR   3 Preferred Brand $40.00$80.00P
RECOMBIVAX HB 40MCG/ML VIAL   3 Preferred Brand $40.00$80.00P
REGRANEX 0.01% GEL   5 Specialty Tier 33%33%P Q:15
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RELENZA 5MG DISKHALER   4 Non-Preferred Brand 45%45%None
RELISTOR 12 MG/0.6 ML SYRINGE   5 Specialty Tier 33%33%P
RELISTOR 12 MG/0.6 ML VIAL   5 Specialty Tier 33%33%P
RELISTOR 150 MG TABLET   5 Specialty Tier 33%33%P
RELISTOR 8 MG/0.4 ML SYRINGE   5 Specialty Tier 33%33%P
REMERON 15MG TABLET   4 Non-Preferred Brand 45%45%Q:45
/30Days
REMERON 30MG TABLET   4 Non-Preferred Brand 45%45%Q:30
/30Days
REMERON SLTABLET 15MG TABLET 30 BLPK CRTN   4 Non-Preferred Brand 45%45%Q:30
/30Days
REMERON SLTABLET 30MG TABLET 30 TABLET S CRTN   4 Non-Preferred Brand 45%45%Q:30
/30Days
REMERON SLTABLET 45MG TABLET   4 Non-Preferred Brand 45%45%Q:30
/30Days
RENVELA 800MG TABLET   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REPAGLINIDE 0.5 MG TABLET [Prandin]   2 Generic $8.00$16.00Q:960
/30Days
REPAGLINIDE 1 MG TABLET [Prandin]   2 Generic $8.00$16.00Q:480
/30Days
REPAGLINIDE 2 MG TABLET [Prandin]   2 Generic $8.00$16.00Q:240
/30Days
REPATHA 140 MG/ML SURECLICK   3 Preferred Brand $40.00$80.00P Q:2
/28Days
REPATHA 140 MG/ML SYRINGE   3 Preferred Brand $40.00$80.00P Q:2
/28Days
REPATHA 420 MG/3.5ML PUSHTRONX   3 Preferred Brand $40.00$80.00P Q:4
/30Days
RESCRIPTOR 200 MG TABLET   4 Non-Preferred Brand 45%45%Q:180
/30Days
RESTASIS 0.05% EYE EMULSION   3 Preferred Brand $40.00$80.00P Q:60
/30Days
RETACRIT 10,000 UNIT/ML VIAL   4 Non-Preferred Brand 45%45%P
RETACRIT 2,000 UNIT/ML VIAL   4 Non-Preferred Brand 45%45%P
RETACRIT 3,000 UNIT/ML VIAL   4 Non-Preferred Brand 45%45%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RETACRIT 4,000 UNIT/ML VIAL   4 Non-Preferred Brand 45%45%P
RETACRIT 40,000 UNIT/ML VIAL   4 Non-Preferred Brand 45%45%P
RETIN-A 0.01% GEL   4 Non-Preferred Brand 45%45%None
RETIN-A 0.025% GEL   4 Non-Preferred Brand 45%45%None
RETROVIR 100mg/1 100 CAPSULE BOTTLE   4 Non-Preferred Brand 45%45%Q:180
/30Days
RETROVIR 50mg/5mL 240 mL in 1 BOTTLE   4 Non-Preferred Brand 45%45%Q:1920
/30Days
REVLIMID 10 MG CAPSULE   5 Specialty Tier 33%33%P Q:30
/30Days
REVLIMID 15MG CAPSULE 21 BOT   5 Specialty Tier 33%33%P Q:21
/28Days
REVLIMID 2.5 MG CAPSULE   5 Specialty Tier 33%33%P Q:30
/30Days
REVLIMID 20 MG CAPSULE   5 Specialty Tier 33%33%P Q:21
/28Days
REVLIMID 25 MG CAPSULE   5 Specialty Tier 33%33%P Q:21
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
REVLIMID 5 MG CAPSULE   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 0.25 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 0.5 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 1 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 2 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 3 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REXULTI 4 MG TABLET   5 Specialty Tier 33%33%P Q:30
/30Days
REYATAZ 150MG CAPSULE   5 Specialty Tier 33%33%Q:30
/30Days
REYATAZ 200MG CAPSULE   5 Specialty Tier 33%33%Q:60
/30Days
REYATAZ 300MG CAPSULE   5 Specialty Tier 33%33%Q:30
/30Days
REYATAZ 50 MG POWDER PACKET   5 Specialty Tier 33%33%Q:240
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RIBASPHERE 200 MG CAPSULE   2 Generic $8.00$16.00None
RIBASPHERE 600MG TABLET   5 Specialty Tier 33%33%None
RIBASPHERE RibaPak 600mg/1   5 Specialty Tier 33%33%None
RIBAVIRIN 200 MG CAPSULE   2 Generic $8.00$16.00None
RIBAVIRIN 200MG TABLET 168 BOT   2 Generic $8.00$16.00None
RIDAURA 3 MG CAPSULE   5 Specialty Tier 33%33%None
RIFABUTIN 150 MG CAPSULE [Mycobutin]   5 Specialty Tier 33%33%None
RIFADIN 150MG CAPSULE   4 Non-Preferred Brand 45%45%None
RIFAMPIN 150 MG CAPSULE   2 Generic $8.00$16.00None
RIFAMPIN 300 MG CAPSULE   2 Generic $8.00$16.00None
RIFAMPIN IV 600 MG VIAL   5 Specialty Tier 33%33%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RILUZOLE 50 MG TABLET [Rilutek]   2 Generic $8.00$16.00None
RISEDRONATE SOD DR 35 MG TABLET DR [Atelvia]   2 Generic $8.00$16.00Q:4
/28Days
RISEDRONATE SODIUM 150 MG TAB [Actonel]   2 Generic $8.00$16.00Q:1
/28Days
RISEDRONATE SODIUM 30 MG TABLET [Actonel]   2 Generic $8.00$16.00Q:30
/30Days
RISEDRONATE SODIUM 35 MG TAB [Actonel]   2 Generic $8.00$16.00Q:4
/28Days
RISEDRONATE SODIUM 35 MG TABLET [Actonel]   2 Generic $8.00$16.00Q:4
/28Days
RISEDRONATE SODIUM 35 MG TABLET [Actonel]   2 Generic $8.00$16.00Q:4
/28Days
RISEDRONATE SODIUM 5 MG TABLET [Actonel]   2 Generic $8.00$16.00Q:30
/30Days
RISPERDAL 0.25 MG TABLET   4 Non-Preferred Brand 45%45%P Q:60
/30Days
RISPERDAL 0.5 MG TABLET   4 Non-Preferred Brand 45%45%P Q:60
/30Days
RISPERDAL 1 MG TABLET   4 Non-Preferred Brand 45%45%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERDAL 1MG/ML SOLUTION   4 Non-Preferred Brand 45%45%P Q:480
/30Days
RISPERDAL 2 MG TABLET   4 Non-Preferred Brand 45%45%P Q:60
/30Days
RISPERDAL 3 MG TABLET   5 Specialty Tier 33%33%P Q:60
/30Days
RISPERDAL 4 MG TABLET   5 Specialty Tier 33%33%P Q:120
/30Days
RISPERDAL CONSTA 25MG SYR   5 Specialty Tier 33%33%P Q:2
/28Days
RISPERDAL CONSTA 37.5MG SYR   5 Specialty Tier 33%33%P Q:2
/28Days
RISPERDAL CONSTA 50MG SYR   5 Specialty Tier 33%33%P Q:2
/28Days
RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL   4 Non-Preferred Brand 45%45%P Q:2
/28Days
RISPERIDONE 0.25 MG TABLET   1 Preferred Generic $2.00$4.00P Q:60
/30Days
RISPERIDONE 0.5 MG ODT   2 Generic $8.00$16.00P Q:60
/30Days
RISPERIDONE 0.5 MG TABLET   1 Preferred Generic $2.00$4.00P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RISPERIDONE 1 MG ODT   2 Generic $8.00$16.00P Q:60
/30Days
RISPERIDONE 1 MG TABLET   1 Preferred Generic $2.00$4.00P Q:60
/30Days
RISPERIDONE 1 MG/ML SOLUTION   2 Generic $8.00$16.00P Q:480
/30Days
RISPERIDONE 2 MG ODT   2 Generic $8.00$16.00P Q:60
/30Days
RISPERIDONE 2 MG TABLET   1 Preferred Generic $2.00$4.00P Q:60
/30Days
RISPERIDONE 3 MG ODT   2 Generic $8.00$16.00P Q:60
/30Days
RISPERIDONE 3 MG TABLET   1 Preferred Generic $2.00$4.00P Q:60
/30Days
RISPERIDONE 4 MG ODT   2 Generic $8.00$16.00P Q:120
/30Days
RISPERIDONE 4 MG TABLET   1 Preferred Generic $2.00$4.00P Q:120
/30Days
RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK   2 Generic $8.00$16.00P Q:60
/30Days
RITALIN 10MG TABLET   4 Non-Preferred Brand 45%45%Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RITALIN 20MG TABLET   4 Non-Preferred Brand 45%45%Q:90
/30Days
RITALIN 5MG TABLET   4 Non-Preferred Brand 45%45%Q:90
/30Days
RITONAVIR 100 MG TABLET [Norvir]   2 Generic $8.00$16.00Q:360
/30Days
RIVASTIGMINE 1.5 MG CAPSULE   2 Generic $8.00$16.00None
RIVASTIGMINE 13.3 MG/24HR PTCH   2 Generic $8.00$16.00None
RIVASTIGMINE 3 MG CAPSULE   2 Generic $8.00$16.00None
RIVASTIGMINE 4.5 MG CAPSULE   2 Generic $8.00$16.00None
RIVASTIGMINE 4.6 MG/24HR PATCH   2 Generic $8.00$16.00None
RIVASTIGMINE 6 MG CAPSULE   2 Generic $8.00$16.00None
RIVASTIGMINE 9.5 MG/24HR PATCH   2 Generic $8.00$16.00None
RIZATRIPTAN 10 MG ODT [Maxalt-MLT]   2 Generic $8.00$16.00Q:18
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RIZATRIPTAN 10 MG TABLET [Maxalt]   2 Generic $8.00$16.00Q:18
/30Days
RIZATRIPTAN 5 MG ODT [Maxalt-MLT]   2 Generic $8.00$16.00Q:18
/30Days
RIZATRIPTAN 5 MG TABLET [Maxalt]   2 Generic $8.00$16.00Q:18
/30Days
Rocaltrol 0.25ug GELATIN COATED 100 CAPSULE BOTTLE   4 Non-Preferred Brand 45%45%None
Rocaltrol 0.5ug GELATIN COATED 100 CAPSULE BOTTLE   4 Non-Preferred Brand 45%45%None
Rocaltrol 1ug/mL 15 mL in 1 BOTTLE   4 Non-Preferred Brand 45%45%None
ROPINIROLE HCL 0.25 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL 0.5 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL 1 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL 2 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL 3 MG TABLET   2 Generic $8.00$16.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROPINIROLE HCL 4 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL 5 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL ER 12 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL ER 2 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL ER 4 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL ER 6 MG TABLET   2 Generic $8.00$16.00None
ROPINIROLE HCL ER 8 MG TABLET   2 Generic $8.00$16.00None
ROSUVASTATIN CALCIUM 10 MG TAB [Crestor]   2 Generic $8.00$16.00Q:45
/30Days
ROSUVASTATIN CALCIUM 20 MG TAB [Crestor]   2 Generic $8.00$16.00Q:45
/30Days
Rosuvastatin Calcium 40 mg Film Coated Tablet [Crestor]   2 Generic $8.00$16.00Q:30
/30Days
ROSUVASTATIN CALCIUM 5 MG TAB [Crestor]   2 Generic $8.00$16.00Q:45
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ROTARIX VACCINE SUSPENSION   3 Preferred Brand $40.00$80.00None
ROTATEQ VACCINE Solution   3 Preferred Brand $40.00$80.00None
Rowasa Rectal 4 G 60 ml Kit 28X60   4 Non-Preferred Brand 45%45%None
Roweepra 1,000 mg tablet   2 Generic $8.00$16.00None
ROWEEPRA 500 MG TABLET   2 Generic $8.00$16.00None
Roweepra 750 mg tablet   2 Generic $8.00$16.00None
ROXICODONE 15 MG TABLET   4 Non-Preferred Brand 45%45%Q:180
/30Days
ROXICODONE 30 MG TABLET   4 Non-Preferred Brand 45%45%Q:180
/30Days
ROXICODONE 5 MG TABLET   4 Non-Preferred Brand 45%45%Q:360
/30Days
RUBRACA 200 MG TABLET   5 Specialty Tier 33%33%P Q:120
/30Days
RUBRACA 250 MG TABLET   5 Specialty Tier 33%33%P Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
RUBRACA 300 MG TABLET   5 Specialty Tier 33%33%P Q:120
/30Days
RYDAPT 25 MG CAPSULE   5 Specialty Tier 33%33%P Q:240
/30Days
RYTHMOL SR 225mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE   5 Specialty Tier 33%33%None
RYTHMOL SR 325mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE   5 Specialty Tier 33%33%None
RYTHMOL SR 425mg/1 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE   5 Specialty Tier 33%33%None

Chart Legend:

Below are a few notes to help you understand the above 2019 Medicare Part D BlueRx Enhanced Plus (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 $415 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 $3820) at a "Preferred" network pharmacy. In most cases, the "Preferred" 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 2019 )

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.








Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.