2012 Medicare Part D Plan Formulary Information |
Ozark Health Plan - Dual Plus (HMO SNP) (H5416-019-0)
Sanctioned Plan
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The Ozark Health Plan - Dual Plus (HMO SNP) (H5416-019-0) Formulary Drugs Starting with the Letter D in Dade County, MO: CMS MA Region 15 which includes: MO
|
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 |
D5W/KCL 20MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover D5W/KCL 20MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
D5W/KCL 30MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover D5W/KCL 30MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DACARBAZINE 200MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in MO cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in MO cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
daunorubicin hydrochloride 5mg/mL 10 VIAL in 1 CARTON / 4 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in MO cover daunorubicin hydrochloride 5mg/mL 10 VIAL in 1 CARTON / 4 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEPADE 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEPADE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE HCL 75MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE HCL 75MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE HYDROCHLORIDE TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE HYDROCHLORIDE TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in MO cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Desmopressin Acetate 0.1mg/mL 1 VIAL in 1 CARTON / 2.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in MO cover Desmopressin Acetate 0.1mg/mL 1 VIAL in 1 CARTON / 2.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in MO cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESONIDE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MO cover DESONIDE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESONIDE 0.05% OINTMENT 60GM TUBE ![Compare how all Medicare Part D PDP plans in MO cover DESONIDE 0.05% OINTMENT 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Desoximetasone 2.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in MO cover Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | 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 MO cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in MO cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXRAZOXANE 500MG VIAL ![Compare how all Medicare Part D PDP plans in MO cover DEXRAZOXANE 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in MO cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE 5% AND 0.9% NACL INJECTION 5-900 24 X 500ML BAG ![Compare how all Medicare Part D PDP plans in MO 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 |
N/A | N/A | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Dextrose in Lactated Ringers 0.02; 5; 0.03; 0.6; 0.31g/100mL; g/100mL; g/100mL; g/100mL; g/100mL 12 ![Compare how all Medicare Part D PDP plans in MO cover Dextrose in Lactated Ringers 0.02; 5; 0.03; 0.6; 0.31g/100mL; g/100mL; g/100mL; g/100mL; g/100mL 12.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | 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 MO cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE INJECTION 10 250ML X 24 BOTPL ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE INJECTION 10 250ML X 24 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in MO cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC SOD 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC SOD 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOFENAC SODIUM 75MG TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover DICLOFENAC SODIUM 75MG TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in MO cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | P |
DICYCLOMINE 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MO cover DICYCLOMINE 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in MO cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MO cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | P |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in MO cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MO cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in MO cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIFLUNISAL 500MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in MO cover Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Digoxin 125ug/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Digoxin 125ug/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Digoxin 250ug/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Digoxin 250ug/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in MO cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Dihydroergotamine Mesylate 1mg/mL 10 VIAL in 1 BOX / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in MO cover Dihydroergotamine Mesylate 1mg/mL 10 VIAL in 1 BOX / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILT-CD 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in MO cover DILT-CD 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILT-CD DILTIAZEM HCL ER CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in MO cover DILT-CD DILTIAZEM HCL ER CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in MO cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DILTIAZEM CD CAPSULES 120MG (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM CD CAPSULES 120MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM CD CAPSULES 240MG (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM CD CAPSULES 240MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM CD CAPSULES 300MG (90 CT) ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM CD CAPSULES 300MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM ER 420MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM ER 420MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DILTIAZEM HCL 60MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM HCL 60MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM HCL 60MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM HCL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diltiazem Hydrochloride 90mg/1 100 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Diltiazem Hydrochloride 90mg/1 100 CAPSULE, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTIAZEM INJ 25MG/5ML ![Compare how all Medicare Part D PDP plans in MO cover DILTIAZEM INJ 25MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 120MG ![Compare how all Medicare Part D PDP plans in MO cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 180MG ![Compare how all Medicare Part D PDP plans in MO cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 180MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 240MG ![Compare how all Medicare Part D PDP plans in MO cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 240MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in MO cover DILTZAC DILTIAZEM HYDROCHLORIDE EXTENDED RELEASE CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIPHENHYDRAMINE HCL INJECTION 50MG 1 VIAL ![Compare how all Medicare Part D PDP plans in MO cover DIPHENHYDRAMINE HCL INJECTION 50MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg/1; mg/1 100 TABLET in 1 BOTTLE, PLAST ![Compare how all Medicare Part D PDP plans in MO cover Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg/1; mg/1 100 TABLET in 1 BOTTLE, PLAST.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | P |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in MO cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
Dipyridamole 25mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Dipyridamole 25mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Dipyridamole 75mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Dipyridamole 75mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DIPYRIDAMOLE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DIPYRIDAMOLE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in MO cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in MO cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in MO cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIVALPROEX SODIUM COATED PARTICLES IN CAPSULES 125MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DIVALPROEX SODIUM COATED PARTICLES IN CAPSULES 125MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
donepezil hydrochloride 10mg/1 ![Compare how all Medicare Part D PDP plans in MO cover donepezil hydrochloride 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
donepezil hydrochloride 5mg/1 ![Compare how all Medicare Part D PDP plans in MO cover donepezil hydrochloride 5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | Q:30 /30Days |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MO cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in MO cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | Q:45 /30Days |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in MO cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Dorzolamide HCL Timolol Maleate Ophthalmic Solution 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER i ![Compare how all Medicare Part D PDP plans in MO cover Dorzolamide HCL Timolol Maleate Ophthalmic Solution 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER i.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Doxazosin 2mg/1 100 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in MO cover Doxazosin 2mg/1 100 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in MO cover DOXAZOSIN MESYLATE TABLETS 8 MG .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in MO cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Doxepin Hydrochloride 150mg/1 100 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
Doxepin Hydrochloride 50mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in MO cover Doxepin Hydrochloride 50mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in MO cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXORUBICIN HCL INJECTION USP 200MG/100ML 1 X 100ML VIALMD ![Compare how all Medicare Part D PDP plans in MO 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 |
N/A | N/A | P |
DOXORUBICIN HCL SOLUTION INJECTION USP 2MG 100ML VIALMD ![Compare how all Medicare Part D PDP plans in MO cover DOXORUBICIN HCL SOLUTION INJECTION USP 2MG 100ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in MO cover Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MO cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN ![Compare how all Medicare Part D PDP plans in MO 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 |
N/A | N/A | None |
Doxycycline Hyclate 100mg/1 50 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 50 CAPSULE in 1 BOTTLE, PLAST ![Compare how all Medicare Part D PDP plans in MO cover Doxycycline Hyclate 100mg/1 50 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 50 CAPSULE in 1 BOTTLE, PLAST.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
N/A | N/A | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MO cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in MO cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DOXYCYCLINE TABLETS 150MG 30 BOT ![Compare how all Medicare Part D PDP plans in MO cover DOXYCYCLINE TABLETS 150MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | None |
DURAMORPH 0.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MO cover DURAMORPH 0.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |
DURAMORPH 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MO cover DURAMORPH 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
N/A | N/A | P |