Drug - Brand Name (Generic Name) PA Status Class Drug Notes Rybrevant (amivantamab-vmjw) - PA PA CHEMOTHERAPY "Recombinate (antihemophilic factor, recombinant-Recombinate)" ANTI-HEMOPHILIA AGENTS Ridaura (auranofin) IMMUNOMODULATOR Regranex (becaplermin) - PA PA DERMATOLOGICAL Rezurock (belumosudil) - PA PA MISCELLANEOUS Rexulti (brexpiprazole) - PA; See Table 24; See Table 71 PA ANTIPSYCHOTIC "Ruconest (c1 esterase inhibitor, recombinant-Ruconest) - PA" PA ENZYMES Rayaldee (calcifediol) - PA PA ELECTROLYTES AND NUTRIENTS Rytary (carbidopa / levodopa extended-release capsule) - PA PA ANTIPARKINSON "Rebinyn (coagulation factor IX recombinant, glycopegylated-Rebinyn)" ANTI-HEMOPHILIA AGENTS "Rixubis (coagulation factor IX, recombinant)" ANTI-HEMOPHILIA AGENTS Restasis Multidose (cyclosporine multidose 0.05% ophthalmic emulsion) - PA PA OPHTHALMIC PREPARATIONS Rimso-50 (dimethyl sulfoxide solution) ANALGESICS Radicava (edaravone injection) - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS Radicava ORS (edaravone suspension) - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS Revcovi (elapegademase-lvlr) - PA PA ENZYMES Rozlytrek (entrectinib) - PA PA CHEMOTHERAPY Retacrit (epoetin alfa-epbx) - PA PA HEMATINIC AGENT Repatha (evolocumab) - PA PA LIPID LOWERING AGENTS "Rebyota (fecal microbiota, live-jslm) - PA" PA MISCELLANEOUS Riastap (fibrinogen concentrate) ANTI-HEMOPHILIA AGENTS Releuko (filgrastim-ayow) HEMATINIC AGENT Ravicti (glycerol phenylbutyrate) - PA PA ENZYMES Recarbrio (imipenem / cilastatin / relebactam) - PA PA ANTIBIOTICS Renflexis (infliximab-abda) - PA PA IMMUNOMODULATOR Remicade (infliximab-Remicade) - PA PA IMMUNOMODULATOR Rezvoglar (insulin glargine-aglr) - PA PA DIABETIC AGENTS Rebif (interferon beta-1a-Rebif) MULTIPLE SCLEROSIS AGENTS Reyvow (lasmiditan) - PA PA SEROTONIN RECEPTOR AGENTS Recorlev (levoketoconazole) - PA PA OTHER HORMONES Riomet ER (metformin extended-release suspension) - PA PA DIABETIC AGENTS Rasuvo (methotrexate subcutaneous injection-Rasuvo) - PA PA IMMUNOMODULATOR Reditrex (methotrexate subcutaneous injection-Reditrex) - PA PA IMMUNOMODULATOR Relistor (methylnaltrexone) - PA PA CONSTIPATION AGENTS Relexxii (methylphenidate extended-release-Relexxii) - PA; See Table 31; See Table 71 PA CNS STIMULANTS Ritalin LA (methylphenidate-Ritalin LA) - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS Rydapt (midostaurin) - PA PA CHEMOTHERAPY Relafen DS (nabumetone 1000 mg) - PA PA NONSTEROIDAL ANTI-INFLAMMATORY Rhopressa (netarsudil) - PA PA OPHTHALMIC PREPARATIONS Rocklatan (netarsudil / latanoprost) - PA PA OPHTHALMIC PREPARATIONS Rectiv (nitroglycerin 0.4% ointment) GASTROINTESTINAL AGENT Ryaltris (olopatadine / mometasone) - PA PA NASAL PREPARATIONS Rezlidhia (olutasidenib) - PA PA CHEMOTHERAPY Rhofade (oxymetazoline cream) - PA PA DERMATOLOGICAL "Ryplazim (plasminogen, human-tvmh) - PA" PA HEMOSTATICS Rayos (prednisone delayed-release) - PA PA GLUCOCORTICOIDS Reese's Pinworm (pyrantel pamoate) ANTIPARASITICS rabeprazole delayed-release capsule - PA PA PROTON PUMP INHIBITORS "rabies immune globulin IM, human-Hyperrab" BIOLOGICAL "rabies immune globulin IM, human-Kedrab" BIOLOGICAL rabies virus vaccine-Imovax Rabies BIOLOGICAL rabies virus vaccine-Rabavert BIOLOGICAL Rabavert (rabies virus vaccine-Rabavert) BIOLOGICAL raltegravir ANTIVIRALS ranolazine extended-release granules - PA PA CARDIOVASCULAR regorafenib - PA PA CHEMOTHERAPY relugolix - PA PA HORMONE AGENTS relugolix / estradiol / norethindrone - PA PA OTHER HORMONES respiratory syncytial virus vaccine - PA < 60 years PA BIOLOGICAL "respiratory syncytial virus vaccine, adjuvanted - PA < 60 years" PA BIOLOGICAL revefenacin - PA PA BRONCHODILATORS rezafungin - PA PA ANTIFUNGALS Rezzayo (rezafungin) - PA PA ANTIFUNGALS "rho(d) immune globulin IM, human-Hyperrho" BIOLOGICAL "rho(d) immune globulin IM, human-Micrhogam" BIOLOGICAL "rho(d) immune globulin IM, human-Rhogam" BIOLOGICAL "Rhogam (rho(d) immune globulin IM, human-Rhogam)" BIOLOGICAL ribociclib - PA PA CHEMOTHERAPY ribociclib / letrozole - PA PA CHEMOTHERAPY rifamycin - PA PA ANTIBIOTICS rifapentine TB PREPARATIONS rifaximin 200 mg ANTIBIOTICS rifaximin 550 mg - PA PA ANTIBIOTICS rilonacept - PA PA BIOLOGICAL riluzole film - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS riluzole suspension - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS rimabotulinumtoxinB - PA PA BIOLOGICAL "ringers solution, lactated" ANTIBACTERIALS AND ANTISEPTICS riociguat - PA PA CARDIOVASCULAR ripretinib - PA PA CHEMOTHERAPY risankizumab-rzaa - PA PA IMMUNOMODULATOR risdiplam - PA PA BIOLOGICAL "risperidone 25 mg, 37.5 mg, 50 mg extended-release intramuscular injection-Rykindo - PA; See Table 24; See Table 71" PA ANTIPSYCHOTIC "Rykindo (risperidone 25 mg, 37.5 mg, 50 mg extended-release intramuscular injection-Rykindo) - PA; See Table 24; See Table 71" PA ANTIPSYCHOTIC ritlecitinib - PA PA IMMUNOMODULATOR "ritonavir packet, solution" ANTIVIRALS "rivaroxaban 10 mg, 15 mg, 20 mg tablet, starter pack" ANTICOAGULANTS rivaroxaban 2.5 mg tablet - PA > 2 units/day PA > 2 units/day ANTICOAGULANTS rivaroxaban suspension - PA ≥ 18 years PA ≥ 18 years ANTICOAGULANTS roflumilast cream - PA PA DERMATOLOGICAL rolapitant injection - PA > 2 vials/28 days PA > 2 vials/28 days ANTIEMETICS romosozumab-aqqg - PA PA BIOLOGICAL ropeginterferon alfa-2b-njft - PA PA CHEMOTHERAPY rosuvastatin sprinkle capsule - PA PA LIPID LOWERING AGENTS rucaparib - PA PA CHEMOTHERAPY Rubraca (rucaparib) - PA PA CHEMOTHERAPY ruxolitinib cream - PA PA DERMATOLOGICAL ruxolitinib tablet - PA PA CHEMOTHERAPY Retevmo (selpercatinib) - PA PA CHEMOTHERAPY Rybelsus (semaglutide tablet) - PA PA DIABETIC AGENTS Ragwitek (short ragweed pollen allergen extract) - PA PA ALLERGENS Relyvrio (sodium phenylbutyrate / sodium taurursodiol) - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS Restoril (temazepam 22.5 mg) - PA; See Table 69; See Table 71 PA BENZODIAZEPINES Rinvoq (upadacitinib) - PA PA IMMUNOMODULATOR Relenza (zanamivir) - PA 20 inhalations/ claim and PA > 40 inhalations/ 365 days PA 20 inhalations/ claim and PA > 40 inhalations/ 365 days ANTIVIRALS Relpax (eletriptan) A90 - PA PA TRIPTAN A90 Rowasa Kit (mesalamine kit) A90 - PA PA GI ANTI-INFLAMMATORY A90 Remeron Sol Tab (mirtazapine orally disintegrating tablet) A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 ranolazine extended-release tablet A90 CARDIOVASCULAR A90 rasagiline A90 - PA > 1 unit/day PA > 1 unit/day ANTIPARKINSON A90 ribavirin 200 mg capsule A90 - PA PA ANTIVIRALS A90 ribavirin tablet A90 ANTIVIRALS A90 rimantadine A90 ANTIVIRALS A90 "risperidone 0.25 mg, 0.5 mg, 1 mg, 2 mg orally disintegrating tablet A90 - PA 2 units/day; See Table 24; See Table 71" PA 2 units/day ANTIPSYCHOTIC A90 "risperidone 3 mg, 4 mg orally disintegrating tablet A90 - PA; See Table 24; See Table 71" PA ANTIPSYCHOTIC A90 rivastigmine capsule A90 - PA > 2 units/day PA > 2 units/day ALZHEIMER'S THERAPY A90 ropinirole A90 ANTIPARKINSON A90 ropinirole extended-release A90 ANTIPARKINSON A90 Revatio (sildenafil 20 mg tablet) A90 - PA PA CARDIOVASCULAR A90 Retin-A Micro (tretinoin microspheres) A90 - PA PA DERMATOLOGICAL A90 Reyataz # (atazanavir) A90 ANTIVIRALS "A90, #" Restasis # (cyclosporine 0.05% ophthalmic emulsion) A90 OPHTHALMIC PREPARATIONS "A90, #" Razadyne ER # (galantamine extended-release capsule) A90 - PA > 1 unit/day PA > 1 unit/day ALZHEIMER'S THERAPY "A90, #" Rowasa # (mesalamine enema) A90 GI ANTI-INFLAMMATORY "A90, #" Robaxin # (methocarbamol) A90 - PA < 16 years PA MUSCLE RELAXANT "A90, #" Reglan # (metoclopramide) A90 ANTIEMETICS "A90, #" Remeron # (mirtazapine) A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" rifampin A90; See Table 35; See Table 66 ANTIBIOTICS "A90, #" Rifadin # (rifampin) A90; See Table 35; See Table 66 ANTIBIOTICS "A90, #" riluzole tablet A90 AMYOTROPHIC LATERAL SCLEROSIS AGENTS "A90, #" Rilutek # (riluzole tablet) A90 AMYOTROPHIC LATERAL SCLEROSIS AGENTS "A90, #" "risperidone 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg tablets A90 - PA 2 units/day; See Table 24; See Table 71" PA 2 units/day ANTIPSYCHOTIC "A90, #" "Risperdal # (risperidone 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg tablets) A90 - PA 2 units/day; See Table 24; See Table 71" PA 2 units/day ANTIPSYCHOTIC "A90, #" risperidone 4 mg tablet A90 - PA 4 units/day; See Table 24; See Table 71 PA 4 units/day ANTIPSYCHOTIC "A90, #" Risperdal # (risperidone 4 mg tablet) A90 - PA 4 units/day; See Table 24; See Table 71 PA 4 units/day ANTIPSYCHOTIC "A90, #" risperidone solution A90 - PA 16 mL/day; See Table 24; See Table 71 PA 16 mL/day ANTIPSYCHOTIC "A90, #" Risperdal # (risperidone solution) A90 - PA 16 mL/day; See Table 24; See Table 71 PA 16 mL/day ANTIPSYCHOTIC "A90, #" rizatriptan orally disintegrating tablet A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" rizatriptan tablet A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" Renvela # (sevelamer carbonate) A90 ELECTROLYTES AND NUTRIENTS "A90, #" Renagel # (sevelamer hydrochloride) A90 ELECTROLYTES AND NUTRIENTS "A90, #" Rapamune # (sirolimus tablet) A90 IMMUNOMODULATOR "A90, #" Retrovir # (zidovudine) A90 ANTIVIRALS "A90, #" repaglinide M90 DIABETIC AGENTS M90 repaglinide / metformin M90 - PA PA DIABETIC AGENTS M90 risedronate M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 roflumilast tablet M90 - PA PA UNCLASSIFIED DRUG PRODUCTS M90 Rapaflo (silodosin) M90 - PA PA BENIGN PROSTATIC HYPERPLASIA AGENTS M90 "Rocaltrol # (calcitriol capsule, solution) M90" ELECTROLYTES AND NUTRIENTS "M90, #" Riomet # (metformin immediate-release solution) M90 - PA ≥ 13 years PA ≥ 13 years DIABETIC AGENTS "M90, #" Rythmol SR # (propafenone extended-release) M90 CARDIOVASCULAR "M90, #" rabeprazole delayed-release tablet M90 - PA > 1 unit/day PA > 1 unit/day PROTON PUMP INHIBITORS "M90, #" raloxifene M90 HORMONE REPLACEMENT THERAPY "M90, #" ramipril M90 CARDIOVASCULAR "M90, #" rosuvastatin 40 mg M90 - PA > 1 unit/day PA > 1 unit/day LIPID LOWERING AGENTS "M90, #" "rosuvastatin 5 mg, 10 mg, 20 mg M90 - PA > 1.5 units/day" PA > 1.5 units/day LIPID LOWERING AGENTS "M90, #" "Roctavian (valoctocogene roxaparvovec-rvox) CO, MB - PA" PA MISCELLANEOUS "CO, MB" Rukobia (fostemsavir) PD - PA PA ANTIVIRALS PD rimegepant PD - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR PD "risperidone 150 mg, 200 mg, 250 mg extended-release subcutaneous injection PD - PA 1 injection/56 days; See Table 24; See Table 71" PA 1 injection/56 days ANTIPSYCHOTIC PD "risperidone 50 mg, 75 mg, 100 mg, 125 mg extended-release subcutaneous injection PD - PA 1 injection/28 days; See Table 24; See Table 71" PA 1 injection/28 days ANTIPSYCHOTIC PD "risperidone 90 mg, 120 mg extended-release subcutaneous injection PD - PA 1 injection/28 days; See Table 24; See Table 71" PA 1 injection/28 days ANTIPSYCHOTIC PD rilpivirine BP ANTIVIRALS BP "risperidone 12.5 mg, 25 mg, 37.5 mg, 50 mg extended-release intramuscular injection-Risperdal Consta BP - PA 2 injections/28 days; See Table 24; See Table 71" PA 2 injections/28 days ANTIPSYCHOTIC BP "Risperdal Consta (risperidone 12.5 mg, 25 mg, 37.5 mg, 50 mg extended-release intramuscular injection-Risperdal Consta) BP - PA 2 injections/28 days; See Table 24; See Table 71" PA 2 injections/28 days ANTIPSYCHOTIC BP rotigotine transdermal system BP - PA > 1 unit/day PA > 1 unit/day ANTIPARKINSON BP Remodulin (treprostinil injection) BP - PA PA CARDIOVASCULAR BP "Revlimid (lenalidomide) BP, A90 - PA" PA CHEMOTHERAPY "BP, A90" "ramelteon BP, A90 - PA > 1 unit/day" PA > 1 unit/day SEDATIVES "BP, A90" "Rozerem (ramelteon) BP, A90 - PA > 1 unit/day" PA > 1 unit/day SEDATIVES "BP, A90" "rifabutin BP, A90" ANTIBIOTICS "BP, A90" "rivastigmine patch BP, A90 - PA > 1 unit/day" PA > 1 unit/day ALZHEIMER'S THERAPY "BP, A90" "rufinamide BP, A90 - PA" PA ANTICONVULSANTS "BP, A90" "Revatio (sildenafil oral suspension-Revatio) BP, A90 - PA" PA CARDIOVASCULAR "BP, A90" "Rapamune (sirolimus solution) BP, A90" IMMUNOMODULATOR "BP, A90" "Retin-A (tretinoin-Retin-A) BP, A90 - PA ≥ 22 years" PA ≥ 22 years DERMATOLOGICAL "BP, A90" "risedronate delayed-release BP, M90 - PA" PA ELECTROLYTES AND NUTRIENTS "BP, M90" "ritonavir tablet BP, PD, A90" ANTIVIRALS "BP, PD, A90" Ritalin # (methylphenidate-Ritalin) - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS # Roxicodone # (oxycodone immediate-release) - PA > 80 mg/day PA > 80 mg/day OPIOID ANALGESICS # "Restoril # (temazepam 7.5 mg, 15 mg, 30 mg) - PA 1 unit/day; See Table 69; See Table 71" PA 1 unit/day BENZODIAZEPINES # Rylaze (asparaginase erwinia chrysanthemi-rywn) MB - PA PA CHEMOTHERAPY MB Ryanodex (dantrolene injection suspension) MB MUSCLE RELAXANT MB Rolvedon (eflapegrastim-xnst) MB HEMATINICS & BLOOD CELL STIMULATORS MB Retisert (fluocinolone ophthalmic implant-Retisert) MB OPHTHALMIC PREPARATIONS MB Reblozyl (luspatercept-aamt) MB - PA PA HEMATOLOGIC MB ramucirumab MB - PA PA CHEMOTHERAPY MB ranibizumab MB OPHTHALMIC PREPARATIONS MB ranibizumab-eqrn MB OPHTHALMIC PREPARATIONS MB ranibizumab-nuna MB OPHTHALMIC PREPARATIONS MB rasburicase MB ENZYMES MB ravulizumab-cwvz MB - PA PA BIOLOGICAL MB remdesivir MB COVID - 19 related Treatments and Vaccines MB remimazolam MB - PA PA BENZODIAZEPINES MB reslizumab MB - PA PA BIOLOGICAL MB retifanlimab-dlwr MB - PA PA CHEMOTHERAPY MB "rho(d) immune globulin IV, human-Rhophylac MB" BIOLOGICAL MB "Rhophylac (rho(d) immune globulin IV, human-Rhophylac) MB" BIOLOGICAL MB "rho(d) immune globulin IV, human-Winrho SDF MB" BIOLOGICAL MB rituximab MB - PA PA CHEMOTHERAPY MB Rituxan (rituximab) MB - PA PA CHEMOTHERAPY MB rituximab / hyaluronidase human MB - PA PA CHEMOTHERAPY MB Rituxan Hycela (rituximab / hyaluronidase human) MB - PA PA CHEMOTHERAPY MB rituximab-abbs MB - PA PA CHEMOTHERAPY MB rituximab-arrx MB - PA PA CHEMOTHERAPY MB Riabni (rituximab-arrx) MB - PA PA CHEMOTHERAPY MB rituximab-pvvr MB - PA PA CHEMOTHERAPY MB Ruxience (rituximab-pvvr) MB - PA PA CHEMOTHERAPY MB romidepsin lyophilized MB - PA PA CHEMOTHERAPY MB romidepsin non-lyophilized MB - PA PA CHEMOTHERAPY MB romiplostim MB - PA PA HEMATINIC AGENT MB ropivacaine MB ANESTHETICS MB rozanolixizumab-noli MB - PA PA MULTIPLE SCLEROSIS AGENTS MB Rystiggo (rozanolixizumab-noli) MB - PA PA MULTIPLE SCLEROSIS AGENTS MB Reclast (zoledronic acid 5 mg) MB ELECTROLYTES AND NUTRIENTS MB Recombivax HB (hepatitis B recombinant vaccine) 1 BIOLOGICAL 1 "rotavirus vaccine, live, oral 1" BIOLOGICAL 1 "Rotarix (rotavirus vaccine, live, oral) 1" BIOLOGICAL 1 "rotavirus vaccine, live, oral, pentavalent 1" BIOLOGICAL 1 "Rotateq (rotavirus vaccine, live, oral, pentavalent) 1" BIOLOGICAL 1 "retinol *, M90" ELECTROLYTES AND NUTRIENTS "*, M90" "riboflavin *, M90" ELECTROLYTES AND NUTRIENTS "*, M90"