bullet point: •
| Brand-Name Drug | Number of PDP Formularies | Number of MAPD Formularies |
| DILANTIN 30 MG CAPSULE | 35 | 299 |
| EDURANT PED 2.5MG TABLET FOR SUSPENSION | 35 | 299 |
| HERNEXEOS 60 MG TABLET | 35 | 299 |
| IBTROZI 200 MG CAPSULE | 35 | 299 |
| KERENDIA 40 MG TABLET | 35 | 287 |
| MODEYSO 125 MG CAPSULE | 35 | 299 |
| PAXLOVID 150-100 MG FILM COATED TABLET 2 Blister Packs 10/Package | 35 | 299 |
| PENMENVY MEN A-B-C-W-Y KIT | 35 | 298 |
| 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] | 34 | 260 |
| CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION [Tegretol] | 35 | 299 |
| ENOXAPARIN 150 MG/ML SYRINGE [Lovenox] | 35 | 299 |
| KLOR-CON M10 MEQ TABLET [Klotrix] | 35 | 232 |
| MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [PURIXAN] | 35 | 299 |
| MICROGESTIN FE 1-20 TABLET [Tarina Fe 1/20] | 33 | 288 |
| MICROGESTIN FE 1.5-30 TABLET | 33 | 281 |
| NECON 0.5-35-28 TABLET [WERA] | 32 | 211 |
| ORQUIDEA 0.35 MG TABLET [Sharobel 28-Day] | 34 | 272 |
| PERAMPANEL 2 MG TABLET [Fycompa] | 33 | 295 |
| PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin] | 35 | 299 |
| PROPAFENONE HCL 150 MG TABLET [Rythmol] | 35 | 299 |
| RIVAROXABAN 1 MG/ML ORAL SUSPENSION [Xarelto] | 31 | 235 |
| SACUBITRIL-VALSARTAN 24-26 MG TABLET [Entresto] | 35 | 283 |
| SRONYX 0.10-0.02 MG TABLET [Vienva] | 33 | 278 |
| TOPIRAMATE 25 MG/ML SOLUTION [EPRONTIA] | 35 | 299 |
| VANCOMYCIN HCL 250 MG CAPSULE [Vancocin] | 35 | 298 |
| 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 | ||||||||