2011 Medicare Part D Plan Formulary Information |
AARP MedicareRx Enhanced (PDP) (S5921-249-0)
Benefit Details
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The AARP MedicareRx Enhanced (PDP) (S5921-249-0) Formulary Drugs Starting with the Letter D in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
Drugs Starting with Letter D
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
D.H.E.45 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MT cover D.H.E.45 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | S |
D5W/KCL 20MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover D5W/KCL 20MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
D5W/KCL 30MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover D5W/KCL 30MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DACARBAZINE 200MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DACOGEN FOR INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DACOGEN FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | None |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DANTRIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTRIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DANTRIUM 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTRIUM 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANTRIUM 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTRIUM 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in MT cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in MT cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in MT cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DARAPRIM 25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DARAPRIM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DAUNORUBICIN HYDROCHLORIDE POWDER FOR INJECTION USP ![Compare how all Medicare Part D PDP plans in MT cover DAUNORUBICIN HYDROCHLORIDE POWDER FOR INJECTION USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DAUNOXOME INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DAUNOXOME INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DAYPRO 600MG CAPLET ![Compare how all Medicare Part D PDP plans in MT cover DAYPRO 600MG CAPLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAYTRANA 10MG/9 HR PATCH ![Compare how all Medicare Part D PDP plans in MT cover DAYTRANA 10MG/9 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:31 /31Days |
DAYTRANA 15MG/9 HR PATCH ![Compare how all Medicare Part D PDP plans in MT cover DAYTRANA 15MG/9 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:31 /31Days |
DAYTRANA ER PATCH 55MG 30 CRTN ![Compare how all Medicare Part D PDP plans in MT cover DAYTRANA ER PATCH 55MG 30 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:31 /31Days |
DDAVP 0.01% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in MT cover DDAVP 0.01% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DDAVP 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DDAVP 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DDAVP 0.2MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DDAVP 0.2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DDAVP 4MCG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MT cover DDAVP 4MCG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | S |
DDAVP SOLUTION INTRANASAL 0.1MG/ML 2.5 ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DDAVP SOLUTION INTRANASAL 0.1MG/ML 2.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DECAVAC VACCINE 2;5 UNT/0.5 ML ![Compare how all Medicare Part D PDP plans in MT cover DECAVAC VACCINE 2;5 UNT/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEGARELIX INJ ![Compare how all Medicare Part D PDP plans in MT cover DEGARELIX INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | P Q:2 /28Days |
DEGARELIX SOLR ![Compare how all Medicare Part D PDP plans in MT cover DEGARELIX SOLR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DELATESTRYL 200 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DELATESTRYL 200 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | P |
DELESTROGEN 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DELESTROGEN 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DELESTROGEN INJECTION 10MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in MT cover DELESTROGEN INJECTION 10MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DELESTROGEN INJECTION 20MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in MT cover DELESTROGEN INJECTION 20MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMADEX TABLETS 10MG 10 GM BOT ![Compare how all Medicare Part D PDP plans in MT cover DEMADEX TABLETS 10MG 10 GM BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMADEX TABLETS 20MG 20 MG BOT ![Compare how all Medicare Part D PDP plans in MT cover DEMADEX TABLETS 20MG 20 MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMADEX TBALETS 5MG 5 MG BOT ![Compare how all Medicare Part D PDP plans in MT cover DEMADEX TBALETS 5MG 5 MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMECLOCYCLINE HCL 150MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEMECLOCYCLINE HCL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEMECLOCYCLINE HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEMECLOCYCLINE HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEMEROL 100MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEMEROL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S |
DEMEROL 25MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in MT cover DEMEROL 25MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEMEROL 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEMEROL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S |
DEMEROL 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEMEROL 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMEROL INJECTION 75MG/ML ![Compare how all Medicare Part D PDP plans in MT cover DEMEROL INJECTION 75MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPACON INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in MT cover DEPACON INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPADE 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEPADE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEPAKENE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DEPAKENE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKENE 250MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MT cover DEPAKENE 250MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKOTE 125MG SPRINKLE CAP ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE 125MG SPRINKLE CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKOTE 125MG TABLET EC ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE 125MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEPAKOTE 250MG TABLET EC ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE 250MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKOTE 500MG TABLET EC ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE 500MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKOTE ER 250MG TABLET SA ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE ER 250MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPAKOTE ER 500MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEPAKOTE ER 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in MT cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-MEDROL 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-MEDROL 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-MEDROL 40MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-MEDROL 40MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-MEDROL 80MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-MEDROL 80MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-PROVERA 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-PROVERA 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEPO-SUBQ PRO 104 MG PFS 0.65 ML ![Compare how all Medicare Part D PDP plans in MT cover DEPO-SUBQ PRO 104 MG PFS 0.65 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEPO-TESTOSTERONE 100MG/ML ![Compare how all Medicare Part D PDP plans in MT cover DEPO-TESTOSTERONE 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | P |
DEPO-TESTOSTERONE 200MG/ML ![Compare how all Medicare Part D PDP plans in MT cover DEPO-TESTOSTERONE 200MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | P |
DERMA-SMOOTHE/FS 0.01% BODY OIL ![Compare how all Medicare Part D PDP plans in MT cover DERMA-SMOOTHE/FS 0.01% BODY OIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DERMATOP 0.1% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DERMATOP 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DERMATOP 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in MT cover DERMATOP 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DERMOTIC 0.01% DROPS ![Compare how all Medicare Part D PDP plans in MT cover DERMOTIC 0.01% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESIPRAMINE HCL 75MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE HCL 75MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE HYDROCHLORIDE TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE HYDROCHLORIDE TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESMOPRESSIN 0.1MG/ML SOL ![Compare how all Medicare Part D PDP plans in MT cover DESMOPRESSIN 0.1MG/ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in MT cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in MT cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESOGEN 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in MT cover DESOGEN 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DESONATE GEL 0.05% ![Compare how all Medicare Part D PDP plans in MT cover DESONATE GEL 0.05%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DESONIDE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DESONIDE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESONIDE 0.05% LOTION ![Compare how all Medicare Part D PDP plans in MT cover DESONIDE 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESONIDE 0.05% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in MT cover DESONIDE 0.05% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DESOWEN CREAM 0.05% 60GM TUBE ![Compare how all Medicare Part D PDP plans in MT cover DESOWEN CREAM 0.05% 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DESOWEN LOTION 0.05% 1X4 FL OZ PKGCOM ![Compare how all Medicare Part D PDP plans in MT cover DESOWEN LOTION 0.05% 1X4 FL OZ PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DESOWEN OINTMENT 0.05% KIT WITH 1X60GM TUBE PKGCOM ![Compare how all Medicare Part D PDP plans in MT cover DESOWEN OINTMENT 0.05% KIT WITH 1X60GM TUBE PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DESOXIMETASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DESOXIMETASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESOXIMETASONE 0.05% GEL ![Compare how all Medicare Part D PDP plans in MT cover DESOXIMETASONE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESOXIMETASONE 0.25% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DESOXIMETASONE 0.25% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESOXIMETASONE 0.25% OINT ![Compare how all Medicare Part D PDP plans in MT cover DESOXIMETASONE 0.25% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DESOXYN 5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DESOXYN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:155 /31Days |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXAMETHASONE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DEXAMETHASONE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DEXASPORIN EYE DROPS ![Compare how all Medicare Part D PDP plans in MT cover DEXASPORIN EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXCHLORPHEN 2MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MT cover DEXCHLORPHEN 2MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DEXEDRINE D-AMPHETAMINE SULFATE 10MG CAPSULE SA ORAL ![Compare how all Medicare Part D PDP plans in MT cover DEXEDRINE D-AMPHETAMINE SULFATE 10MG CAPSULE SA ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:155 /31Days |
DEXEDRINE D-AMPHETAMINE SULFATE 15MG CAPSULE SA ORAL ![Compare how all Medicare Part D PDP plans in MT cover DEXEDRINE D-AMPHETAMINE SULFATE 15MG CAPSULE SA ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:124 /31Days |
DEXEDRINE SPANSULE 5MG 90 EA ![Compare how all Medicare Part D PDP plans in MT cover DEXEDRINE SPANSULE 5MG 90 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in MT cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DEXILANT CAPSULES DELAYED RELEASE 60 MG ![Compare how all Medicare Part D PDP plans in MT cover DEXILANT CAPSULES DELAYED RELEASE 60 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:62 /31Days |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:248 /31Days |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:124 /31Days |
DEXRAZOXANE 10 MG/ML INJECTABLE SOLUTION [ZINECARD] ![Compare how all Medicare Part D PDP plans in MT cover DEXRAZOXANE 10 MG/ML INJECTABLE SOLUTION [ZINECARD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | None |
DEXRAZOXANE 500MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover DEXRAZOXANE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:186 /31Days |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:372 /31Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:186 /31Days |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:124 /31Days |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MT cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:155 /31Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE 5% AND 0.9% NACL INJECTION 5-900 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE 5% AND 0.9% NACL INJECTION 5-900 24 X 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE AND ELECTROLYTE NO 48 INJECTION 5% 500ML BAG ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE AND ELECTROLYTE NO 48 INJECTION 5% 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE INJECTION 10 250ML X 24 BOTPL ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE INJECTION 10 250ML X 24 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in MT cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIABETA 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIABETA 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIABETA TABLETS 2.5MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIABETA TABLETS 2.5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIABETA TABLETS 5MG 1000 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIABETA TABLETS 5MG 1000 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIAMOX SEQUELS 500MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DIAMOX SEQUELS 500MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIBENZYLINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DIBENZYLINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOFENAC POTASSIUM 25 MG ORAL CAPSULE [ZIPSOR] ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC POTASSIUM 25 MG ORAL CAPSULE [ZIPSOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S Q:124 /31Days |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOFENAC SOD 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC SOD 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOFENAC SODIUM 75MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DICLOFENAC SODIUM 75MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in MT cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICYCLOMINE 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MT cover DICYCLOMINE 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MT cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIDANOSINE 200MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DIDANOSINE 200MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIDANOSINE 250MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DIDANOSINE 250MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIDRONEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIDRONEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFFERIN 0.1% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DIFFERIN 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFFERIN 0.1% GEL ![Compare how all Medicare Part D PDP plans in MT cover DIFFERIN 0.1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFFERIN 0.3% GEL ![Compare how all Medicare Part D PDP plans in MT cover DIFFERIN 0.3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFFERIN LOTION ![Compare how all Medicare Part D PDP plans in MT cover DIFFERIN LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in MT cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIFLUCAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN 150MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN 200MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 200MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN 50MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN 50MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUCAN INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DIFLUCAN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIFLUNISAL 500MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIGOXIN 125MCG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIGOXIN 125MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIGOXIN 250MCG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MT cover DIGOXIN 250MCG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIGOXIN 50MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in MT cover DIGOXIN 50MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in MT cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIHYDROERGOTAMINE 1MG/ML AM ![Compare how all Medicare Part D PDP plans in MT cover DIHYDROERGOTAMINE 1MG/ML AM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILACOR XR 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DILACOR XR 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILACOR XR 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DILACOR XR 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILACOR XR 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DILACOR XR 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in MT cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILANTIN CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DILANTIN CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in MT cover DILANTIN-125 SUS 125/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILATRATE-SR 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DILATRATE-SR 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HP HYDROMORPHONE HCL INJECTION 10MG/ML ML VIALSD ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HP HYDROMORPHONE HCL INJECTION 10MG/ML ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL INJECTION 2MG/ML 10 AMP BOX ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL INJECTION 2MG/ML 10 AMP BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL INJECTION 4MG/ML 10 AMP BOX ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL INJECTION 4MG/ML 10 AMP BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILAUDID HYDROMORPHONE HYDROCHLORIDE INJECTION 1MG/ML 10 AMPULES BOX ![Compare how all Medicare Part D PDP plans in MT cover DILAUDID HYDROMORPHONE HYDROCHLORIDE INJECTION 1MG/ML 10 AMPULES BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DILT-CD 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in MT cover DILT-CD 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILT-CD DILTIAZEM HCL ER CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in MT cover DILT-CD DILTIAZEM HCL ER CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM 24HR ER 180 MG TAB ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 24HR ER 180 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DILTIAZEM 24HR ER 240 MG TAB ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 24HR ER 240 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DILTIAZEM 24HR ER 300 MG TAB ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 24HR ER 300 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DILTIAZEM 24HR ER 360 MG TAB ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 24HR ER 360 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DILTIAZEM 24HR ER 420 MG TAB ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 24HR ER 420 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DILTIAZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM CD CAPSULES 120MG (90 CT) ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM CD CAPSULES 120MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM CD CAPSULES 240MG (90 CT) ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM CD CAPSULES 240MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM CD CAPSULES 300MG (90 CT) ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM CD CAPSULES 300MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM ER 420MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM ER 420MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HCL 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HCL 60MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HCL 60MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HCL 60MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HCL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES USP 90MG 1 BLPK ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES USP 90MG 1 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTIAZEM HYDROCHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MT cover DILTIAZEM HYDROCHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 120MG ![Compare how all Medicare Part D PDP plans in MT cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 180MG ![Compare how all Medicare Part D PDP plans in MT cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 180MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 240MG ![Compare how all Medicare Part D PDP plans in MT cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in MT cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DILTZAC ER CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DILTZAC ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIOVAN 160MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIOVAN 320MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DIOVAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIOVAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIOVAN HCT 160/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN HCT 160/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIOVAN HCT 160/25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN HCT 160/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIOVAN HCT 320/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN HCT 320/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIOVAN HCT 320/25MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN HCT 320/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DIOVAN HCT 80/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DIOVAN HCT 80/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DIPHENHYDRAMINE 50MG CAPS ![Compare how all Medicare Part D PDP plans in MT cover DIPHENHYDRAMINE 50MG CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIPHENHYDRAMINE HCL ELIXIR 12.5MG/5ML 20 ML PKG ![Compare how all Medicare Part D PDP plans in MT cover DIPHENHYDRAMINE HCL ELIXIR 12.5MG/5ML 20 ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIPHENHYDRAMINE HCL INJECTION 50MG 1 VIAL ![Compare how all Medicare Part D PDP plans in MT cover DIPHENHYDRAMINE HCL INJECTION 50MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in MT cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIPHTHERIA-TETANUS TOX-PED .17;6.7;5 MG/5ML;LF ![Compare how all Medicare Part D PDP plans in MT cover DIPHTHERIA-TETANUS TOX-PED .17;6.7;5 MG/5ML;LF.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DIPROLENE 0.05% LOTION ![Compare how all Medicare Part D PDP plans in MT cover DIPROLENE 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIPROLENE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in MT cover DIPROLENE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIPROLENE AF 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MT cover DIPROLENE AF 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIPYRIDAMOLE TABETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIPYRIDAMOLE TABETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIPYRIDAMOLE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIPYRIDAMOLE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIPYRIDAMOLE TABLETS 75MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIPYRIDAMOLE TABLETS 75MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DITROPAN XL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DITROPAN XL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DITROPAN XL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DITROPAN XL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DITROPAN XL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DITROPAN XL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:31 /31Days |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in MT cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIURIL SODIUM 500MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover DIURIL SODIUM 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIVALPROEX SODIUM 250MG TBEC ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM 250MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIVALPROEX SODIUM 500MG TBEC ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM 500MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIVALPROEX SODIUM COATED PARTICLES IN CAPSULES 125MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM COATED PARTICLES IN CAPSULES 125MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DIVIGEL 1MG(0.1%) GEL IN PACKET ![Compare how all Medicare Part D PDP plans in MT cover DIVIGEL 1MG(0.1%) GEL IN PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:60 /31Days |
DOLOPHINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DOLOPHINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DOLOPHINE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DOLOPHINE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:62 /31Days |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MT cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DORIBAX FOR INJECTION 500MG/VIAL ![Compare how all Medicare Part D PDP plans in MT cover DORIBAX FOR INJECTION 500MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DORYX 100MG TABLET DR ![Compare how all Medicare Part D PDP plans in MT cover DORYX 100MG TABLET DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DORYX 75MG TABLET DR ![Compare how all Medicare Part D PDP plans in MT cover DORYX 75MG TABLET DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DORYX DELAYED RELEASE TABLETS 150MG ![Compare how all Medicare Part D PDP plans in MT cover DORYX DELAYED RELEASE TABLETS 150MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in MT cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | Q:10 /31Days |
DORZOLAMIDE HCL TIMOLOL MALEATE OPHTHALMIC SOLUTION 22.3;6.8MG/ML; ![Compare how all Medicare Part D PDP plans in MT cover DORZOLAMIDE HCL TIMOLOL MALEATE OPHTHALMIC SOLUTION 22.3;6.8MG/ML;.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | Q:10 /31Days |
DOVONEX CREAM ![Compare how all Medicare Part D PDP plans in MT cover DOVONEX CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DOVONEX SOLUTION ![Compare how all Medicare Part D PDP plans in MT cover DOVONEX SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXAZOSIN MESYLATE TABLET 2MG (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXAZOSIN MESYLATE TABLET 2MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXAZOSIN MESYLATE TABLET 8MG (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXAZOSIN MESYLATE TABLET 8MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN 50 MG ORAL CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN 50 MG ORAL CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in MT cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | P |
DOXIL INJECTION 2MG ![Compare how all Medicare Part D PDP plans in MT cover DOXIL INJECTION 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | P |
DOXORUBICIN HCL INJECTION USP 200MG/100ML 1 X 100ML VIALMD ![Compare how all Medicare Part D PDP plans in MT cover DOXORUBICIN HCL INJECTION USP 200MG/100ML 1 X 100ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | P |
DOXORUBICIN HCL SOLUTION INJECTION USP 2MG 100ML VIALMD ![Compare how all Medicare Part D PDP plans in MT cover DOXORUBICIN HCL SOLUTION INJECTION USP 2MG 100ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXYCYCLINE 100MG VIAL ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXYCYCLINE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE HYCLATE 100MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE HYCLATE 100MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE HYCLATE 100MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE HYCLATE 100MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic Brand |
$4.00 | $8.00 | None |
DOXYCYCLINE HYCLATE 75MG CAPSULE DELAYED RELEASE (60 CT) ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE HYCLATE 75MG CAPSULE DELAYED RELEASE (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DOXYCYCLINE TABLETS 150MG 30 BOT ![Compare how all Medicare Part D PDP plans in MT cover DOXYCYCLINE TABLETS 150MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in MT cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | P |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in MT cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | P Q:186 /31Days |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in MT cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | P Q:186 /31Days |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DUETACT 30MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DUETACT 30MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DUETACT 30MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DUETACT 30MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DUONEB INHALATION SOLUTION 3-.5MG 60 X 3ML CRTN ![Compare how all Medicare Part D PDP plans in MT cover DUONEB INHALATION SOLUTION 3-.5MG 60 X 3ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | P |
DURAGESIC PATCH 100 MCG/HR ![Compare how all Medicare Part D PDP plans in MT cover DURAGESIC PATCH 100 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Specialty |
33% | 33% | S Q:31 /31Days |
DURAGESIC PATCH 12.5 MCG/HR ![Compare how all Medicare Part D PDP plans in MT cover DURAGESIC PATCH 12.5 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S Q:15 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DURAGESIC PATCH 50 CG/HR ![Compare how all Medicare Part D PDP plans in MT cover DURAGESIC PATCH 50 CG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S Q:15 /31Days |
DURAGESIC PATCH 75 MCG/HR ![Compare how all Medicare Part D PDP plans in MT cover DURAGESIC PATCH 75 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | S Q:31 /31Days |
DURAMORPH 0.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MT cover DURAMORPH 0.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DURAMORPH 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MT cover DURAMORPH 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Generic Preferred Brand |
$40.00 | $105.00 | None |
DUREZOL OPHTHALMIC EMULSION 0.05% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in MT cover DUREZOL OPHTHALMIC EMULSION 0.05% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYAZIDE 37.5/25 CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DYAZIDE 37.5/25 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYNACIN 50MG TABLET ![Compare how all Medicare Part D PDP plans in MT cover DYNACIN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYNACIN MINOCYCLINE HCL TABLETS 100MG 50 BOT ![Compare how all Medicare Part D PDP plans in MT cover DYNACIN MINOCYCLINE HCL TABLETS 100MG 50 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYNACIN MINOCYCLINE HCL TABLETS 75MG 100 BOT ![Compare how all Medicare Part D PDP plans in MT cover DYNACIN MINOCYCLINE HCL TABLETS 75MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYNACIRC CR TABLETS 10 MG ![Compare how all Medicare Part D PDP plans in MT cover DYNACIRC CR TABLETS 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:62 /31Days |
DYNACIRC CR TABLETS 5 MG ![Compare how all Medicare Part D PDP plans in MT cover DYNACIRC CR TABLETS 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | Q:93 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DYRENIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DYRENIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |
DYRENIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MT cover DYRENIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Generic Non-Preferred Brand |
$79.00 | $222.00 | None |