2013 Medicare Part D Plan Formulary Information |
Presbyterian MediCare PPO Plan 2 with Rx (PPO) (H3206-001-0)
Benefit Details
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The Presbyterian MediCare PPO Plan 2 with Rx (PPO) (H3206-001-0) Formulary Drugs Starting with the Letter D in GRANT County, NM: CMS MA Region 20 which includes: NM
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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 |
Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM cover Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in NM cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in NM cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in NM cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DARAPRIM 25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover DARAPRIM 25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DECAVAC VACCINE 2;5 UNT/0.5 ML ![Compare how all Medicare Part D PDP plans in NM cover DECAVAC VACCINE 2;5 UNT/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DEGARELIX INJ ![Compare how all Medicare Part D PDP plans in NM cover DEGARELIX INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in NM cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in NM cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in NM cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DESONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in NM cover DESONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NM 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) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM cover DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DESVENLAFAXINE ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in NM cover DESVENLAFAXINE ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:30 /30Days |
DESVENLAFAXINE ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in NM cover DESVENLAFAXINE ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P Q:30 /30Days |
DETROL LA 2MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in NM cover DETROL LA 2MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S |
DETROL LA 4MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in NM cover DETROL LA 4MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | S |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in NM cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROAMP-AMPHET ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 15 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHET ER 20 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 30 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMP-AMPHET ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:180 /30Days |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:180 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:90 /30Days |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in NM cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE INJECTION 10 250ML X 24 BOTPL ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE INJECTION 10 250ML X 24 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in NM cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM cover Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM 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) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
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 NM 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) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diazepam 20mg/4mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 4 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM 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) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Diazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Diazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diazepam 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Diazepam 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM cover Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | 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 NM 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) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in NM cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in NM cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in NM cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NM 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) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | 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 NM cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in NM cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in NM cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in NM cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in NM cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Dificid 200mg/1 1 BOTTLE in 1 CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in NM 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) |
5 |
Specialty Tier |
33% | N/A | P Q:20 /30Days |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in NM cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | 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 NM cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in NM cover Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
Digoxin 125ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Digoxin 125ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
Digoxin 250ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Digoxin 250ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
Dihydroergotamine Mesylate 1mg/mL 10 VIAL in 1 BOX / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in NM 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 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILANTIN CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in NM cover DILANTIN CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL ![Compare how all Medicare Part D PDP plans in NM cover DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:1500 /30Days |
diltiazem 25 mg/5 ml vial ![Compare how all Medicare Part D PDP plans in NM cover diltiazem 25 mg/5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM CD CAPSULES 120MG (90 CT) ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM CD CAPSULES 120MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM CD CAPSULES 240MG (90 CT) ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM CD CAPSULES 240MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM CD CAPSULES 300MG (90 CT) ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM CD CAPSULES 300MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM HCL 60MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM HCL 60MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DILTIAZEM HCL 60MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DILTIAZEM HCL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIOVAN 160MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DIOVAN 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
DIOVAN 320MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DIOVAN 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
DIOVAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DIOVAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
DIOVAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DIOVAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
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 NM cover Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in NM cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
Dipyridamole 25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Dipyridamole 25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Dipyridamole 75mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Dipyridamole 75mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIPYRIDAMOLE TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in NM cover DIPYRIDAMOLE TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in NM cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in NM cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIVALPROEX SODIUM 125 MG CAP ![Compare how all Medicare Part D PDP plans in NM cover DIVALPROEX SODIUM 125 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in NM cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM cover Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in NM cover DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in NM cover DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Divigel 1.0mg/g 30 PACKET in 1 CARTON / 1.0 g in 1 PACKET ![Compare how all Medicare Part D PDP plans in NM cover Divigel 1.0mg/g 30 PACKET in 1 CARTON / 1.0 g in 1 PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DOCEFREZ 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in NM cover DOCEFREZ 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
DOCEFREZ 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in NM cover DOCEFREZ 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Docetaxel 10mg/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 8 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in NM cover Docetaxel 10mg/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 8 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in NM cover Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in NM cover Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:60 /30Days |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in NM cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DONEPEZIL HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in NM cover DONEPEZIL HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | Q:60 /30Days |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in NM cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM 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) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Doxazosin 2mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Doxazosin 2mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in NM cover DOXAZOSIN MESYLATE TABLETS 8 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in NM cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $4.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 NM 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) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in NM cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in NM cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NM cover Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXYCYCLINE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NM cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN ![Compare how all Medicare Part D PDP plans in NM cover DOXYCYCLINE FOR INJECTION 100MG/VIAL 10 X 1 VIAL CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | 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 NM 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) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in NM cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in NM cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:60 /30Days |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in NM cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in NM cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | P Q:120 /30Days |
DROSPIRENONE-ETH ESTRADIOL TAB ![Compare how all Medicare Part D PDP plans in NM cover DROSPIRENONE-ETH ESTRADIOL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in NM cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in NM cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | S |
DYRENIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DYRENIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |
DYRENIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in NM cover DYRENIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $100.00 | None |