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Medicare Drug List MEDICARE BRANDED MEDICATIONS (B) *Each medication on this list may be available to MEDICARE patient HOWEVER, each manufacturer has varying rules for access to their medications. (examples: income only, denials from Medicaid/LIS, $or% of income spent out of pocket for Rx, donut hole...) MEDPro,LLC will assist patients with the process. *available medications are subject to change *MEDPro,LLC service charges for (B) medications are $20 per month per medication *FPL% of family income varies by manufacturer and by medication The average is typically 300% FPL (reflected in the chart published on website). HOWEVER the Range is 100% FPL – 400% FPL. *contact MEDPro,LLC for medication specific questions and income specific questions @1-888-715-0556 ext 3 BRAND NAME generic name Acular LS Ophthalmic Solution 0.4% ketorolac tromethamine LS OPHTH soln (B) Acular Ophthalmic Solution 0.4% ketorolac tromethamine OPHTH soln (B) Acuvail Ophthalmic Solution 0.45% ketorolac tromethamine OPHTH solution (B) Aczone Gel 5% TOPICAL dapsone gel TOPICAL (B) Adalat CC Tablet nifedipine CC tablet (B) Advair Diskus Inhalation powder fluticasone/salmeterol diskus inhaler (B) Advair HFA Aerosol; Inhalation fluticasone/salmeterol aerosol HFA inhaler (B) Alcaine Ophthalmic Drops 0.5% proparacainehcl OPHTH drops (B) Alomide Ophthalmic Drops 0.1% lodoxamide tromethamine OPHTH drops (B) Alphagan P Ophthalmic Solution 0.1% brimonidine tartrate OPHTH solution (B) Alrex Eye Suspension 0.2% loteprednol ophthalmic susp (B) Altabax Ointment retapamulin ointment (B) Amitiza Capsule lubiprostone capsule (B) Anafranil Capsule clomipramine capsule (B) **add'l copay AndroGel Gel 1% testosterone gel (B) AndroGel Gel 1.62% testosterone gel (B) Apidra SoloStar Pen insulin solostar pen/vials/cartridge (B) Apidra Cartridge insulin solostar pen/vials/cartridge (B) Apidra Vials insulin solostar pen/vials/cartridge (B) Apriso Capsule; Extended-Release mesalamine extended release capsule (B) Aptiom tablets eslicarbazepine acetate tablets (B) Aptivus Capsule tipranavir capsule/oral solution (B) Aptivus Oral Solution tipranavir capsule/oral solution (B) Arcapta Neohaler Powder indaceterol neohaler (B) Arimidex Tablet anastrozole tablet (B) Armour Thyroid Tablet thyroid desiccated tablet (B) Arnuity ELLIPTA Inhaler fluticasone furoate inhalation powder Inhaler (B) Arthrotec tablet diclofenac sodium/misoprostol tablet (B) Asmanex Twisthaler Inhaler & HFA mometasone twisthaler inhaler (B) Atrovent HFA Inhaler ipratropium bromide HFA inhaler (B) Avandia Tablet rosiglitazone tablet (B) *Restrictions by mfr apply Avodart Tablet; Soft Gel dutasteride soft gel tablet (B) Axert Tablet almotriptan malate tablet (B) Azasan Tablet azathioprine tablet (B) Azopt Ophthalmic Suspension 1% brinzolamide OPHTH suspension (B) Azor Tablet amlodipine/olmesartan medoxmil tablet (B) Bactroban Nasal ointment mupirocin calcium Nasal ointment (B) Bactroban Cream mupirocin calcium cream/ointment (B) Baraclude tablets entecavir tablets (B) Beconase AQ Spray; Nasal beclomethasone nasal spray (B) Belsomra tablet suvorexant tablet (B) Bepreve Ophthalmic Solution 1.5% bepotastine besilate ophthalmic soln (B) Besivance Ophthalmic Suspension 0.6% besifloxacin ophthalmic susp (B) Betimol OPHTH solution .25%/.5% timolol ophth solution .25% /.5% (B) Betoptic S Suspension 0.25% betaxolol hcl OPHTH suspension (B) BiDil Tablet isosorbide dinitrate/hydralazine tablet (B) Bleph-10 Ophthalmic Solution sulfacetamide sodium OPHTH solution (B) Breo Ellipta Inhalation Powder fluticasone furoate/vilanterol trifenatate inhaler (B) Brilinta Tablet ticagrelor tablet (B) Brintellix Tablet vortioxetine tablet (B) Bydureon Vial; Subcutaneous - Extended Release exenatide synthetic extended release vial or pen injector (B) Byetta Injection exenatide synthetic extended release vial or pen injector (B) Bystolic Tablet nebivolol tablet (B) Caduet Tablet amlodipine besylate/atorvastatin calcium tablet (B) Canasa Suppository; Rectal 1000mg mesalamine suppository (B) Carbatrol Capsule carbamazepine capsule (B) Carteolol Ophthalmic Solution carteolol OPHTH solution (B) Celebrex Capsule celecoxib capsule (B) Cellcept Capsule mycophenolate mofetil capsule/tablet/oral solution (B) Cellcept Oral Solution mycophenolate mofetil capsule/tablet/oral solution (B) Cellcept Tablet mycophenolate mofetil capsule/tablet/oral solution (B) Chantix Tablet varenicline tablet (B) Cialis Tablet tadalafil tablet (B) Cimzia Injection certolizumab pegol injection (B) Colcrys Tablet colchicine tablet (B) Colestid Granules; Flavored colestipol hydrochloride tablet/granules (B) Colestid Tablet colestipol hydrochloride tablet/granules (B) Combigan Ophthalmic Solution 0.2%/0.5% brimonidine tartrate/timolol maleate OPHTH solution (B) Combivent Respimat Spray Inhaler ipratropium bromide/albuterol inhaler (B) Combivir Tablet lamivudine/zidovudine tablet (B) Complera Tablet emtricitabine/rilpivirine/tenofovir disoproxil fumarate tablet (B) Concerta Tablet; Extended Release methylphenidate extended release tablet (B) Contrave tablets naltrexone HCl/bupropion HCl tablets (B) Coreg CR Capsule; Extended Release carvedilol phosphate extended release capsule (B) Cortef Tablet hydrocortisone tablet (B) Cosopt 2%-0.5% OPHTH solution dorzolamide hcl/timolol maleate ophth solution (B) Creon Capsule; Delayed Release pancrelipase delayed release capsule (B) Crestor Tablet rosuvastatin calcium tablet (B) Crixivan Capsule indinavir capsule (B) Cyclomydril Ophthalmic Solution cyclopentolate hcl/ phenylephrine hcl OPHTH solution (B) Cymbalta Capsule duloxetine HCl capsule (B) Daklinza tablet daclatasvir tablet (B) Daliresp Tablet roflumilast tablet (B) Depo-Estradiol Injection estradiol cypionate injection (B) Depo-Provera Suspension; Injectable medroxyprogesterone acetate susp injection (B) Depo-subQ provera 104 contraceptive Suspension medroxyprogesterone acetate contraceptive susp injection (B) Detrol Tablet tolterodine tartrate AND long-acting LA tablet (B) Dexilant Capsule dexlansoprazole capsule (B) Dilantin Capsule phenytoin capsule/tablet/oral suspension (B) Dilantin Tablet phenytoin capsule/tablet/oral suspension (B) Dilantin-125 Oral Suspension phenytoin capsule/tablet/oral suspension (B) Diprolene Cream betamethasone cream/lotion/ointment (B) Diprolene Lotion betamethasone cream/lotion/ointment (B) Diprolene Ointment betamethasone cream/lotion/ointment (B) Donnatal tablets & elixir phenobarbital,hyosyamine sulfate, atropine sulfate, scopolamine hydrobromide tablets & elixir (B) Duac Gel clindamycin phosphate/benzoyl peroxide topical gel (B) Duavee Tablet conjugated estrogens/bazedoxifene tablet (B) Dulera Aerosol Inhaler mometasone furoate/formoterol fumarate dihydrate inhaler (B) Duragesic CII Patch fentanyl transdermal system patch (B) *CII Phcy Card Durezol OPHTH solution .05% difluprednate ophth emulsion (B) Edarbi Tablet azilsartan medoxomil tablet (B) Edarbyclor Tablet azilartan medoxomil/chlorthalidone tablet (B) Edurant Tablet rilpivirne tablet (B) Effexor XR Capsule; Extended Release venlafaxine hydrochloride XR (extended release) capsule (B) Effient Tablet prasugrel tablet (B) Eliquis Tablet apixaban tablet (B) Elmiron Capsule pentosan polysulfate sodium capsule (B) Emadine Ophthalmic Solution emedastine OPHTH Solution (B) Emtriva Capsule emtricitabine capsule/oral solution (B) Emtriva Oral Solution emtricitabine capsule/oral solution (B) Entresto tablets sucubitril/valsartan tablets (B) Epivir Oral Solution lamivudine tablet/oral solution (B) Epivir Tablet lamivudine tablet/oral solution (B) Epivir-HBV Oral Solution lamivudine-HBV tablet/oral solution (B) Epivir-HBV Tablet lamivudine-HBV tablet/oral solution (B) Epzicom Tablet abacavir/lamivudine tablet (B) Equetro Capsule; Extended Release carbamazepine Extended Release capsule (B) Erivedge Capsule vismodegib capsule (B) Estring Vaginal Ring estradiol vaginal ring (B) Evista Tablet raloxifene HCl tablet (B) Exalgo Tablet CII hydromorphone tablet (B) *CII Phcy Card **add'l copay Exjade Tablet deferasirox tablet (B) Fabior Foam tazarotene topical foam (B) Farxiga tablet dapagliflozin tablet (B) Feldene Capsule piroxicam capsule (B) Fetzima Capsule levomilnacipran HCl capsule(B) Fetzima Capsule; Extended Release; Titration Pack combination pack levomilnacipran HCl capsule(B) Flarex Ophthalmic Suspension fluorometholone OPHTH suspension (B) Flovent Diskus Powder; Inhalation fluticasone diskus inhaler (B) Flovent HFA Aerosol; Inhalation fluticasone HFA aerosol inhaler (B) Focalin XR Capsule; Extended-Release dexmethyiphenidate HCI extended release capsule CII Phcy Card Forteo Injectable; Subcutaneous teriparatide injectable, sc (B) Fosrenol Tablet; Chewable lanthanum carbonate chewable tablet (B) Frova Tablet frovatriptan succinate tablet (B) Fulyzaq tablets crofelemer tablets (B) Fycompa Tablet perampanel tablet (B) Gelnique Gel 3%, 10% oxybutynin gel (B) Gengraf Capsule cyclosporine capsule (B) Giazo Tablets balsalazide disodium capsule/tablet (B) Gilenya Capsule fingolimod capsule (B) Gliadel Wafer; olifeprosan 20 with carmustine implant 7.75mg wafer (B) Glyset Tablet miglitol tablet (B) Glyxambi tablet empaglifolozin/linagliptin tablet (B) Harvoni tablet ledipasvir/sofosbuvir tablet (B) Hepsera Tablet adefovir dipivoxil tablet (B) Hetlioz capsule tasimelteon capsule(B) Humalog Mix 50/50 Injection insulin(B) Humalog Mix 75/25 Injection insulin(B) Humalog Injection insulin(B) Humatrope Vial somatropin (rDNA) vial (B) Humulin 70/30 Injection insulin(B) Humulin N Injection insulin(B) Humulin R Injection insulin(B) Imbruvica™
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