2022 Medicare Part D Plan Formulary Information |
AARP MedicareRx Preferred (PDP) (S5820-010-0)
Benefit Details
This plan covers select insulin pay $35 copay.
See individual insulin cost-sharing below. |
The AARP MedicareRx Preferred (PDP) (S5820-010-0) Formulary Drugs Starting with the Letter N in CMS PDP Region 11 which includes: FL
|
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 |
NABUMETONE 500 MG TABLET [Relafen] |
2 |
Generic |
$10.00 | $0.00 | None |
NABUMETONE 750 MG TABLET [Relafen] |
2 |
Generic |
$10.00 | $0.00 | None |
NADOLOL 20 MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
NADOLOL 40 MG TABLET [Corgard] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NADOLOL 80 MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAFCILLIN 1 GM VIAL |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAFCILLIN 10 GM BULK VIAL |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAFCILLIN 2 GM VIAL |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAFTIFINE HCL 1% CREAM (G) [Naftin-MP] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAFTIFINE HCL 2% CREAM (G) [Naftin] |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NAFTIN 2% GEL |
4 |
Non-Preferred Drug |
40% | 40% | None |
NALOXONE 0.4 MG/ML CARPUJECT CARTRIDGE [Narcan] |
2 |
Generic |
$10.00 | $0.00 | None |
NALOXONE 0.4 MG/ML VIAL [Narcan] |
2 |
Generic |
$10.00 | $0.00 | None |
naloxone 1 mg/ml syringe |
2 |
Generic |
$10.00 | $0.00 | None |
NALOXONE HCL 4 MG NASAL SPRAY [Narcan] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NALTREXONE 50 MG TABLET [ReVia] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NAMZARIC 14 MG-10 MG CAPSULE |
3 |
Preferred Brand |
$45.00 | $120.00 | P Q:30 /30Days |
NAMZARIC 21 MG-10 MG CAPSULE |
3 |
Preferred Brand |
$45.00 | $120.00 | P Q:30 /30Days |
NAMZARIC 28 MG-10 MG CAPSULE |
3 |
Preferred Brand |
$45.00 | $120.00 | P Q:30 /30Days |
NAMZARIC 7 MG-10 MG CAPSULE |
3 |
Preferred Brand |
$45.00 | $120.00 | P Q:30 /30Days |
NAMZARIC TITRATION PACK |
3 |
Preferred Brand |
$45.00 | $120.00 | P Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NAPROXEN 125 MG/5 ML ORAL SUSPENSION [Naprosyn] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NAPROXEN 250 MG TABLET [Naprosyn] |
2 |
Generic |
$10.00 | $0.00 | None |
NAPROXEN 375 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
NAPROXEN 500 MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
NAPROXEN DR 375 MG TABLET DR [EC-Naprosyn] |
2 |
Generic |
$10.00 | $0.00 | None |
NAPROXEN DR 500 MG TABLET DR [EC-Naprosyn] |
2 |
Generic |
$10.00 | $0.00 | None |
NARATRIPTAN HCL 1 MG TABLET |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:12 /30Days |
NARATRIPTAN HCL 2.5 MG TABLET |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:12 /30Days |
NARCAN 4 MG NASAL SPRAY |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NATACYN 5% EYE DROPS/EYE DROPPER |
4 |
Non-Preferred Drug |
40% | 40% | None |
NATEGLINIDE 120 MG TABLET [Starlix] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NATEGLINIDE 60 MG TABLET [Starlix] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:180 /30Days |
NATPARA 100 MCG DOSE CARTRIDGE |
5 |
Specialty Tier |
33% | N/A | P |
NATPARA 25 MCG DOSE CARTRIDGE |
5 |
Specialty Tier |
33% | N/A | P |
NATPARA 50 MCG DOSE CARTRIDGE |
5 |
Specialty Tier |
33% | N/A | P |
NATPARA 75 MCG DOSE CARTRIDGE |
5 |
Specialty Tier |
33% | N/A | P |
NAYZILAM 5 MG NASAL SPRAY |
4 |
Non-Preferred Drug |
40% | 40% | P Q:10 /30Days |
NEBIVOLOL 10 MG TABLET [Bystolic] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:30 /30Days |
NEBIVOLOL 2.5 MG TABLET [Bystolic] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:30 /30Days |
NEBIVOLOL 20 MG TABLET [Bystolic] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
NEBIVOLOL 5 MG TABLET [Bystolic] |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:30 /30Days |
NECON 0.5-35-28 TABLET [WERA] |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEFAZODONE HCL 150MG TABLET (60 CT) |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEFAZODONE HCL 250MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEFAZODONE HCL 50MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NEOMYC-POLYM-DEXAMET EYE OINTMENT [Poly-Dex] |
2 |
Generic |
$10.00 | $0.00 | None |
NEOMYC-POLYM-DEXAMETH EYE DROP |
2 |
Generic |
$10.00 | $0.00 | None |
NEOMYCIN SULFATE 500MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NEOMYCIN/POLYMY/HYDRO OTIC SUS |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NERLYNX 40 MG TABLET |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
NEULASTA 6MG/0.6ML SYRINGE |
5 |
Specialty Tier |
33% | N/A | P |
NEUPRO 1 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEUPRO 2 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEUPRO 3 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEUPRO 4 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEUPRO 6 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEUPRO 8 MG/24 HR PATCH |
4 |
Non-Preferred Drug |
40% | 40% | None |
NEVIRAPINE 200 MG TABLET |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [Viramune] |
4 |
Non-Preferred Drug |
40% | 40% | Q:1200 /30Days |
NEVIRAPINE ER 100 MG TABLET ER 24H [Viramune XR] |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
NEVIRAPINE ER 400 MG TABLET ER 24H [Viramune XR] |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
NEXAVAR TABLETS 200MG 120 BOT |
5 |
Specialty Tier |
33% | N/A | P |
NIACIN 500 MG TABLET [Niacor] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NIACIN ER 1,000 MG TABLET ER 24H [Niaspan] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NIACIN ER 500 MG TABLET [Niaspan ER] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NIACIN ER 750 MG TABLET [Niaspan ER] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NIACOR 500 MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL |
4 |
Non-Preferred Drug |
40% | 40% | None |
NIFEDIPINE ER 30 MG TABLET ER [Nifediac CC] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NIFEDIPINE ER 30 MG TABLET ER [Procardia XL] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
NIFEDIPINE ER 60 MG TABLET ER [Nifediac CC] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
NIFEDIPINE ER 60 MG TABLET ER [Procardia XL] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
NIFEDIPINE ER 90 MG TABLET ER [Nifediac CC] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
NIFEDIPINE ER 90 MG TABLET ER [Procardia XL] |
2 |
Generic |
$10.00 | $0.00 | Q:60 /30Days |
NIKKI 3 MG-0.02 MG TABLET [Yaz] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NILUTAMIDE 150 MG TABLET [Nilandron] |
5 |
Specialty Tier |
33% | N/A | None |
NIMODIPINE 30 MG CAPSULE [Nimotop] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NINLARO 2.3 MG CAPSULE |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
NINLARO 3 MG CAPSULE |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
NINLARO 4 MG CAPSULE |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NITAZOXANIDE 500 MG TABLET [Alinia] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NITISINONE 10 MG CAPSULE [Orfadin] |
5 |
Specialty Tier |
33% | N/A | None |
NITISINONE 2 MG CAPSULE [Orfadin] |
5 |
Specialty Tier |
33% | N/A | None |
NITISINONE 5 MG CAPSULE [Orfadin] |
5 |
Specialty Tier |
33% | N/A | None |
NITRO-BID 2% OINTMENT |
4 |
Non-Preferred Drug |
40% | 40% | None |
NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION [Furadantin] |
5 |
Specialty Tier |
33% | N/A | None |
NITROFURANTOIN MCR 100 MG CAPSULE [Macrodantin] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NITROFURANTOIN MCR 50 MG CAPSULE [Macrodantin] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NITROGLYCERIN 0.2 MG/HR PATCH [Nitrodisc] |
2 |
Generic |
$10.00 | $0.00 | None |
NITROGLYCERIN 0.3 MG TABLET SL |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NITROGLYCERIN 0.4 MG SUBLIGUAL TABLET [Nitrotab] |
2 |
Generic |
$10.00 | $0.00 | None |
NITROGLYCERIN 0.4 MG/HR PATCH [Transdermal-NTG] |
2 |
Generic |
$10.00 | $0.00 | None |
NITROGLYCERIN 0.6 MG SUBLIGUAL TABLET [Nitrotab] |
2 |
Generic |
$10.00 | $0.00 | None |
NITROGLYCERIN 0.6 MG/HR PATCH [Transdermal-NTG] |
2 |
Generic |
$10.00 | $0.00 | None |
NITROGLYCERIN 400 MCG SPRAY [Nitrolingual] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX |
2 |
Generic |
$10.00 | $0.00 | None |
NITROSTAT 0.3MG TABLET SL |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NITROSTAT 0.4 MG TABLET SL [Nitrotab] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NITROSTAT 0.6MG TABLET SL |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NIZATIDINE 150 MG CAPSULE [Axid] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NIZATIDINE 300 MG CAPSULE [Axid] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NORA-BE 0.35MG TABLET |
4 |
Non-Preferred Drug |
40% | 40% | None |
noret-estr-fe 0.4-0.035(21)-75 |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORETH-EE-FE 1-0.02(21)-75 TABLET [Tarina Fe 1/20] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORETH-ESTRAD-FE 1-0.02(24)-75 Chewable TABLET [Minastrin] |
4 |
Non-Preferred Drug |
40% | 40% | None |
Norethin-Estrad-Ferr 0.8-0.025 MG |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORETHIN-ETH ESTRAD 1 MG-5 MCG |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NORETHIND-ETH ESTRAD 0.5-2.5 TABLET [Jevantique] |
3 |
Preferred Brand |
$45.00 | $120.00 | None |
NORETHIND-ETH ESTRAD 1-0.02 MG |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORETHINDRONE 0.35 MG TABLET [Sharobel 28-Day] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORETHINDRONE 5MG TABLET |
2 |
Generic |
$10.00 | $0.00 | None |
NORG-EE 0.18-0.215-0.25/0.035 |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NORG-ETHIN ESTRA 0.18-0.215-0.25/0.025 |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORG-ETHIN ESTRA 0.25-0.035 MG TABLET [VyLibra] |
4 |
Non-Preferred Drug |
40% | 40% | None |
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK per CARTON / 21 TABLET per BLISTER PACK |
4 |
Non-Preferred Drug |
40% | 40% | None |
Nortrel (28 Day Regimen) 3 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORTREL 1-0.035MG TABLET 28DAY |
4 |
Non-Preferred Drug |
40% | 40% | None |
Nortrel 7/7/7 (28 Day Regimen) 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER |
4 |
Non-Preferred Drug |
40% | 40% | None |
NORTRIPTYLINE 10 MG/5 ML SOL |
2 |
Generic |
$10.00 | $0.00 | None |
NORTRIPTYLINE HCL 25MG CAP |
2 |
Generic |
$10.00 | $0.00 | None |
NORTRIPTYLINE HCL 50 MG CAP |
2 |
Generic |
$10.00 | $0.00 | None |
NORTRIPTYLINE HCL 75 MG CAPSULE [Pamelor] |
2 |
Generic |
$10.00 | $0.00 | None |
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE BOTTLE |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NORVIR 100 MG POWDER PACKET |
4 |
Non-Preferred Drug |
40% | 40% | Q:360 /30Days |
NORVIR 80MG/ML ORAL SOLUTION |
4 |
Non-Preferred Drug |
40% | 40% | Q:480 /30Days |
NUBEQA 300 MG TABLET |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
NUCALA 100 MG VIAL |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
NUCALA 100 MG/ML AUTO-INJECTOR AUTO INJCT |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
NUCALA 100 MG/ML SYRINGE |
5 |
Specialty Tier |
33% | N/A | P Q:3 /28Days |
NUCYNTA ER 100 MG TABLET ER 12H |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
NUCYNTA ER 150 MG TABLET ER 12H |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
NUCYNTA ER 200 MG TABLET ER 12H |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
NUCYNTA ER 250 MG TABLET ER 12H |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
NUCYNTA ER 50 MG TABLET ER 12H |
3 |
Preferred Brand |
$45.00 | $120.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NUEDEXTA 20; 10mg/1; mg/1 |
4 |
Non-Preferred Drug |
40% | 40% | P Q:60 /30Days |
NUPLAZID 10 MG TABLET |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
NUPLAZID 34 MG CAPSULE |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
NUTRILIPID 20 % EMULSION |
4 |
Non-Preferred Drug |
40% | 40% | P |
NYAMYC 100,000 UNIT/GM POWDER [Pedi-Dri] |
2 |
Generic |
$10.00 | $0.00 | Q:120 /30Days |
NYLIA 1-35 28 TABLET [Pirmella] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NYLIA 7-7-7-28 TABLET [Pirmella] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NYMALIZE 60 MG/10 ML ORAL SYRINGE |
5 |
Specialty Tier |
33% | N/A | None |
NYMYO 0.25-0.035 MG (28) TABLET [VyLibra] |
4 |
Non-Preferred Drug |
40% | 40% | None |
NYSTATIN 100,000 UNIT/GM CREAM (g) [Pediaderm AF] |
2 |
Generic |
$10.00 | $0.00 | None |
NYSTATIN 100,000 UNIT/GM OINTMENT [Nystex] |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
NYSTATIN 100,000 UNIT/GM POWDER [Pedi-Dri] |
2 |
Generic |
$10.00 | $0.00 | Q:120 /30Days |
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [Nystex] |
2 |
Generic |
$10.00 | $0.00 | None |
NYSTATIN 500,000 UNIT ORAL TAB |
2 |
Generic |
$10.00 | $0.00 | None |
NYSTOP 100,000 UNITS/GM POWDER |
2 |
Generic |
$10.00 | $0.00 | Q:120 /30Days |