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Monthly Formulary changes · published Jul 13, 2048



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Brand-Name Drug Number of PDP Formularies Number of MAPD Formularies
DILANTIN 30 MG CAPSULE35299
EDURANT PED 2.5MG TABLET FOR SUSPENSION35299
HERNEXEOS 60 MG TABLET35299
IBTROZI 200 MG CAPSULE35299
KERENDIA 40 MG TABLET35287
MODEYSO 125 MG CAPSULE35299
PAXLOVID 150-100 MG FILM COATED TABLET 2 Blister Packs 10/Package35299
PENMENVY MEN A-B-C-W-Y KIT35298



Generic Drug Equivalent [Brand-Name Drug] Number of PDP Formularies Number of MAPD Formularies
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30]34260
CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [Tegretol]35299
ENOXAPARIN 150 MG/ML SYRINGE [Lovenox]35299
KLOR-CON M10 MEQ TABLET [Klotrix]35232
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [PURIXAN]35299
MICROGESTIN FE 1-20 TABLET [Tarina Fe 1/20]33288
MICROGESTIN FE 1.5-30 TABLET33281
NECON 0.5-35-28 TABLET [WERA]32211
ORQUIDEA 0.35 MG TABLET [Sharobel 28-Day]34272
PERAMPANEL 2 MG TABLET [Fycompa]33295
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin]35299
PROPAFENONE HCL 150 MG TABLET [Rythmol]35299
RIVAROXABAN 1 MG/ML ORAL SUSPENSION [Xarelto]31235
SACUBITRIL-VALSARTAN 24-26 MG TABLET [Entresto]35283
SRONYX 0.10-0.02 MG TABLET [Vienva]33278
TOPIRAMATE 25 MG/ML SOLUTION [EPRONTIA]35299
VANCOMYCIN HCL 250 MG CAPSULE [Vancocin]35298
Beneficiaries who file individual tax returns with income (MAGI) that is: Beneficiaries who file joint tax returns with income that is: Medicare Part D Income Related Monthly Adjustment Amount
2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011
$85,000 or less $170,000 or less $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
$85,000.01 to $87,000 $170,000.01 to $174,000 $12.40 $13.00 $13.30 $12.70 $12.30 $12.10 $11.60 $11.60 $12.00
$87,000.01 to $88,000 $174,000.01 to $176,000 $12.20
$88,000.01 to $91,000 $176,000.01 to $182,000 $12.30
$91,000.01 to $97,000 $182,000.01 to $194,000 $12.40
$97,000.01 to $103,000 $194,000.01 to $206,000 $12.20
$103,000.01 to $106,000 $206,000.01 to $212,000 $12.90
$106,000.01 to $107,000 $212,000.01 to $214,000 $13.70
$107,000.01 to $109,000 $214,000.01 to $218,000 $31.90 $33.60 $34.20 $32.80 $31.80 $31.10 $29.90 $29.90 $31.10
$109,000.01 to $111,000 $218,000.01 to $222,000 $31.50
$111,000.01 to $114,000 $222,000.01 to $228,000 $31.80
$114,000.01 to $123,000 $228,000.01 to $246,000 $32.10
$123,000.01 to $129,000 $246,000.01 to $258,000 $31.50
$129,000.01 to $133,000 $258,000.01 to $266,000 $33.30
$133,000.01 to $133,500 $266,000.01 to $267,000 $35.30
$133,500.01 to $136,000 $267,000.01 to $272,000 $51.40 $54.20
$136,000.01 to $138,000 $272,000.01 to $276,000 $50.70
$138,000.01 to $142,000 $276,000.01 to $284,000 $51.20
$142,000.01 to $153,000 $284,000.01 to $306,000 $51.70
$153,000.01 to $160,000 $306,000.01 to $320,000 $50.70
$160,000.01 to $161,000 $320,000.01 to $322,000 $70.90 $74.80 $55.20 $52.80 $51.30 $50.20 $48.30 $48.10 $50.10
$161,000.01 to $163,000 $322,000.01 to $326,000 $53.80
$163,000.01 to $165,000 $326,000.01 to $330,000 $70.00
$165,000.01 to $167,000 $330,000.01 to $334,000 $70.70
$167,000.01 to $170,000 $334,000.01 to $340,000 $57.00
$170,000.01 to $183,000 $340,000.01 to $366,000 $71.30
$183,000.01 to $193,000 $366,000.01 to $386,000 $70.00
$193,000.01 to $200,000 $386,000.01 to $400,000 $74.20
$200,000.01 to $214,000 $400,000.01 to $428,000 $78.60
$214,000.01 and less than $500,000 $428,000.01 and less than $750,000 $76.20 $72.90 $70.80 $69.30 $66.60 $66.40 $69.10
$500,000 and above $750,000 and above $85.80 $81.00 $76.40 $77.90 $77.10 $76.40 $77.40