2013 Medicare Part D Plan Formulary Information |
WellCare Value (HMO-POS) (H1903-022-0)
Benefit Details
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The WellCare Value (HMO-POS) (H1903-022-0) Formulary Drugs Starting with the Letter D in WEST BATON ROUGE Parish, LA: CMS MA Region 16 which includes: LA
|
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 |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in LA cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in LA cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in LA cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DARAPRIM 25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover DARAPRIM 25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DECAVAC VACCINE 2;5 UNT/0.5 ML ![Compare how all Medicare Part D PDP plans in LA cover DECAVAC VACCINE 2;5 UNT/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DELZICOL DR 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DELZICOL DR 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEMECLOCYCLINE HCL 150MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEMECLOCYCLINE HCL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEMECLOCYCLINE HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEMECLOCYCLINE HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in LA cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in LA cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in LA cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in LA cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | Q:15 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in LA cover DESONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in LA cover Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
desoximetasone 0.05% ointment ![Compare how all Medicare Part D PDP plans in LA cover desoximetasone 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in LA 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) |
1 |
Generic |
$3.00 | $0.00 | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in LA 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) |
1 |
Generic |
$3.00 | $0.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in LA 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) |
1 |
Generic |
$3.00 | $0.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in LA 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) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | 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 LA cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in LA cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in LA cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:31 /31Days |
DEXILANT CAPSULES DELAYED RELEASE 60 MG ![Compare how all Medicare Part D PDP plans in LA cover DEXILANT CAPSULES DELAYED RELEASE 60 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in LA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
Dextrose And Sodium Chloride 5; 0.9g/100mL; g/100mL 24 CONTAINER in 1 CASE / 250 mL in 1 CONTAINER ![Compare how all Medicare Part D PDP plans in LA cover Dextrose And Sodium Chloride 5; 0.9g/100mL; g/100mL 24 CONTAINER in 1 CASE / 250 mL in 1 CONTAINER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
Dextrose in Lactated Ringers 0.02; 5; 0.03; 0.6; 0.31g 12 CONTAINER in 1 CASE ![Compare how all Medicare Part D PDP plans in LA cover Dextrose in Lactated Ringers 0.02; 5; 0.03; 0.6; 0.31g 12 CONTAINER in 1 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE INJECTION 10 250ML X 24 BOTPL ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE INJECTION 10 250ML X 24 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in LA cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam 10mg/2mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 2 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 10mg/2mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 2 mL in 1 SYRINGE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diazepam 2.5mg/0.5mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 0.5 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 2.5mg/0.5mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 0.5 mL in 1 SYRINGE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam 20mg/4mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 4 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 20mg/4mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 4 mL in 1 SYRINGE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diazepam Intensol 5mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in LA cover Diazepam Intensol 5mg/mL 1 BOTTLE, DROPPER in 1 CARTON / 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in LA cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in LA cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in LA cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in LA cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in LA cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in LA cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in LA cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in LA cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Dificid 200mg/1 1 BOTTLE in 1 CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Dificid 200mg/1 1 BOTTLE in 1 CARTON / 20 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFLUNISAL 500MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in LA cover Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Digoxin 125ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Digoxin 125ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Digoxin 250ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Digoxin 250ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in LA cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Dihydroergotamine Mesylate 1mg/mL 10 VIAL in 1 BOX / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in LA 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) |
1 |
Generic |
$3.00 | $0.00 | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in LA cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DILANTIN CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in LA cover DILANTIN CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DILT-CD 120MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in LA cover DILT-CD 120MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILT-CD DILTIAZEM HCL ER CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in LA cover DILT-CD DILTIAZEM HCL ER CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in LA cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
diltiazem 25 mg/5 ml vial ![Compare how all Medicare Part D PDP plans in LA cover diltiazem 25 mg/5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM CD CAPSULES 120MG (90 CT) ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM CD CAPSULES 120MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM CD CAPSULES 240MG (90 CT) ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM CD CAPSULES 240MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM CD CAPSULES 300MG (90 CT) ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM CD CAPSULES 300MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HCL 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM HCL 60MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HCL 60MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM HCL 60MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HCL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
diltiazem hcl er 420 mg cap ![Compare how all Medicare Part D PDP plans in LA cover diltiazem hcl er 420 mg cap.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DILTIAZEM HYDROCHLORIDE ER 360MG CAPSULES ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM HYDROCHLORIDE ER 360MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIOVAN 160MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DIOVAN 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:62 /31Days |
DIOVAN 320MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DIOVAN 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:31 /31Days |
DIOVAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DIOVAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:62 /31Days |
DIOVAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DIOVAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | Q:62 /31Days |
diphenhydramine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in LA cover diphenhydramine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIPHENHYDRAMINE 50MG CAPS ![Compare how all Medicare Part D PDP plans in LA cover DIPHENHYDRAMINE 50MG CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in LA cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Dipyridamole 25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Dipyridamole 25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Dipyridamole 75mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Dipyridamole 75mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIPYRIDAMOLE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in LA cover DIPYRIDAMOLE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in LA cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in LA cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIVALPROEX SODIUM 125 MG CAP ![Compare how all Medicare Part D PDP plans in LA cover DIVALPROEX SODIUM 125 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in LA cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in LA cover DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in LA cover DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in LA cover Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in LA cover Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in LA cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in LA cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in LA cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL ![Compare how all Medicare Part D PDP plans in LA cover Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Doxazosin 2mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Doxazosin 2mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in LA cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in LA cover DOXAZOSIN MESYLATE TABLETS 8 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in LA cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Doxepin Hydrochloride 150mg/1 100 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | 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 LA 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 |
Generic |
$3.00 | $0.00 | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in LA cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in LA cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN ![Compare how all Medicare Part D PDP plans in LA cover DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | 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 LA 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 |
Generic |
$3.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in LA cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in LA cover Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DOXYCYCLINE HYCLATE TAB 150MG ![Compare how all Medicare Part D PDP plans in LA cover DOXYCYCLINE HYCLATE TAB 150MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in LA cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P Q:62 /31Days |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in LA cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P Q:62 /31Days |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in LA cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | P Q:62 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROSPIRENONE-ETH ESTRADIOL TAB ![Compare how all Medicare Part D PDP plans in LA cover DROSPIRENONE-ETH ESTRADIOL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in LA cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | None |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in LA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | Q:13 /30Days |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in LA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Preferred Brand |
$35.00 | $70.00 | Q:13 /30Days |
duramorph 0.5 mg/ml ampule ![Compare how all Medicare Part D PDP plans in LA cover duramorph 0.5 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
duramorph 1 mg/ml ampule ![Compare how all Medicare Part D PDP plans in LA cover duramorph 1 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Generic |
$3.00 | $0.00 | None |
DUREZOL 0.5mg/mL 5 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in LA cover DUREZOL 0.5mg/mL 5 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Non-Preferred Brand |
$79.00 | $158.00 | None |