2014 Medicare Part D Plan Formulary Information |
HumanaChoice H5868-009 (PPO) (H5868-009-0)
Benefit Details
![Email Prescription and/or Health Benefit details for HumanaChoice H5868-009 (PPO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The HumanaChoice H5868-009 (PPO) (H5868-009-0) Formulary Drugs Starting with the Letter D in FREMONT County, IA: CMS MA Region 19 which includes: IA Plan Monthly Premium: $56.00 Deductible: $310 |
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 |
DACARBAZINE 200MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | P |
DACOGEN 50MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in IA cover DACOGEN 50MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA cover Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in IA cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | 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 IA cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in IA cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DARAPRIM 25mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover DARAPRIM 25mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in IA cover daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | P |
DAYTRANA PATCH 1.1 MG/HR ![Compare how all Medicare Part D PDP plans in IA cover DAYTRANA PATCH 1.1 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DAYTRANA PATCH 1.6 MG/HR ![Compare how all Medicare Part D PDP plans in IA cover DAYTRANA PATCH 1.6 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DAYTRANA PATCH 2.2 MG/HR ![Compare how all Medicare Part D PDP plans in IA cover DAYTRANA PATCH 2.2 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DAYTRANA PATCH 3.3 MG/HR ![Compare how all Medicare Part D PDP plans in IA cover DAYTRANA PATCH 3.3 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
Decitabine 50 mg vial [Dacogen] ![Compare how all Medicare Part D PDP plans in IA cover Decitabine 50 mg vial [Dacogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DEGARELIX 240 MG INJ ![Compare how all Medicare Part D PDP plans in IA cover DEGARELIX 240 MG INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DELESTROGEN 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DELESTROGEN 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DELESTROGEN INJECTION 10MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in IA cover DELESTROGEN INJECTION 10MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DELESTROGEN INJECTION 20MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in IA cover DELESTROGEN INJECTION 20MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DEMADEX TABLETS 10MG 10 GM BOT ![Compare how all Medicare Part D PDP plans in IA cover DEMADEX TABLETS 10MG 10 GM BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEMADEX TABLETS 20MG 20 MG BOT ![Compare how all Medicare Part D PDP plans in IA cover DEMADEX TABLETS 20MG 20 MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEMADEX TBALETS 5MG 5 MG BOT ![Compare how all Medicare Part D PDP plans in IA cover DEMADEX TBALETS 5MG 5 MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEMECLOCYCLINE HCL 150MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEMECLOCYCLINE HCL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEMECLOCYCLINE HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEMECLOCYCLINE HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Depacon 100mg/mL 10 VIAL, SINGLE-DOSE in 1 PACKAGE / 5 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in IA cover Depacon 100mg/mL 10 VIAL, SINGLE-DOSE in 1 PACKAGE / 5 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPAKENE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DEPAKENE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Depakene 250mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Depakene 250mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in IA cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
DEPO-MEDROL 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-MEDROL 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPO-MEDROL 40MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-MEDROL 40MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPO-MEDROL 80MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-MEDROL 80MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEPO-PROVERA 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-PROVERA 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:1 /90Days |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IA cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IA cover Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:1 /90Days |
DEPO-TESTOSTERONE 100MG/ML ![Compare how all Medicare Part D PDP plans in IA cover DEPO-TESTOSTERONE 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DEPO-TESTOSTERONE 200MG/ML ![Compare how all Medicare Part D PDP plans in IA cover DEPO-TESTOSTERONE 200MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DERMA-SMOOTHE/FS 0.01% BODY OIL ![Compare how all Medicare Part D PDP plans in IA cover DERMA-SMOOTHE/FS 0.01% BODY OIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DERMATOP 0.1% CREAM ![Compare how all Medicare Part D PDP plans in IA cover DERMATOP 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DERMATOP 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover DERMATOP 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in IA cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in IA cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESOGEN 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in IA cover DESOGEN 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in IA cover DESONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DESONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover DESONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IA 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) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA cover DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
desoximetasone 0.05% ointment ![Compare how all Medicare Part D PDP plans in IA cover desoximetasone 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IA cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IA cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IA 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) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Desoximetasone 2.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IA cover Desoximetasone 2.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DETROL LA 2MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IA cover DETROL LA 2MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days |
DETROL LA 4MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IA cover DETROL LA 4MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 1.5 MGTABLETS ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 1.5 MGTABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Dexamethasone 10 mg/ml vial ![Compare how all Medicare Part D PDP plans in IA cover Dexamethasone 10 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in IA cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in IA cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXILANT CAPSULES DELAYED RELEASE 60 MG ![Compare how all Medicare Part D PDP plans in IA cover DEXILANT CAPSULES DELAYED RELEASE 60 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE ER 15 MG CP ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE ER 15 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE ER 30 MG CP ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE ER 30 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE ER 40 MG CP ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE ER 40 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
dexrazoxane 500 mg vial ![Compare how all Medicare Part D PDP plans in IA cover dexrazoxane 500 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DEXTROAMP-AMPHET ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 15 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 30 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMP-AMPHET ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:180 /30Days |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:90 /30Days |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:120 /30Days |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in IA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:180 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | 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 IA 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 |
$10.00 | $0.00 | 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 IA 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 |
$10.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
DEXTROSE INJECTION 10 250ML X 24 BOTPL ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE INJECTION 10 250ML X 24 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in IA cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA cover Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:120 /30Days |
Diazepam 10mg/2mL 2 SYRINGE, PLASTIC in 1 PACKAGE / 2 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA 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 |
$95.00 | $275.00 | 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 IA 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 |
$95.00 | $275.00 | 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 IA 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 |
$95.00 | $275.00 | None |
Diazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Diazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:90 /30Days |
Diazepam 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Diazepam 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:90 /30Days |
Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA 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 |
$95.00 | $275.00 | Q:1200 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diazepam Intensol 5mg/mL 1 BOTTLE, DROPPER per CARTON / 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in IA cover Diazepam Intensol 5mg/mL 1 BOTTLE, DROPPER per CARTON / 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:1200 /30Days |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in IA cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in IA cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $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 IA 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 |
$10.00 | $0.00 | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in IA cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in IA cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | None |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:60 /30Days |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in IA cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in IA cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:90 /30Days |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IA cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in IA cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DIFLUCAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIFLUCAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DIFLUCAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIFLUCAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DIFLUCAN 200MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in IA cover DIFLUCAN 200MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DIFLUCAN 50MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in IA cover DIFLUCAN 50MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
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 IA cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in IA cover Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
Digoxin 125ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Digoxin 125ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days |
Digoxin 250ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Digoxin 250ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | P |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in IA cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | P |
DILACOR XR 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IA cover DILACOR XR 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:60 /30Days |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in IA cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DILANTIN CAPSULES 30 MG EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in IA cover DILANTIN CAPSULES 30 MG EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in IA cover DILANTIN-125 SUS 125/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DILATRATE-SR 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DILATRATE-SR 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DILT-CD DILTIAZEM HCL ER CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in IA cover DILT-CD DILTIAZEM HCL ER CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in IA cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24HR CD 300 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM 24HR CD 300 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days |
diltiazem 25 mg/5 ml vial ![Compare how all Medicare Part D PDP plans in IA cover diltiazem 25 mg/5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM 30MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM 90MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM CD CAPSULES 120MG (90 CT) ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM CD CAPSULES 120MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DILTIAZEM CD CAPSULES 240MG (90 CT) ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM CD CAPSULES 240MG (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HCL 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM HCL 60MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HCL 60MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM HCL 60MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HCL 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
diltiazem hcl er 420 mg cap ![Compare how all Medicare Part D PDP plans in IA cover diltiazem hcl er 420 mg cap.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days |
Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Diltiazem Hydrochloride 180mg/1 500 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:60 /30Days |
Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Diltiazem Hydrochloride 90mg EXTENDED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DILTIAZEM HYDROCHLORIDE ER 360MG CAPSULES ![Compare how all Medicare Part D PDP plans in IA cover DILTIAZEM HYDROCHLORIDE ER 360MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days |
DIOVAN 160MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DIOVAN 320MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DIOVAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIOVAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DIOVAN HCT 160/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN HCT 160/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:30 /30Days |
DIOVAN HCT 160/25MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN HCT 160/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:30 /30Days |
DIOVAN HCT 320/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN HCT 320/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:30 /30Days |
DIOVAN HCT 320/25MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN HCT 320/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:30 /30Days |
DIOVAN HCT 80/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DIOVAN HCT 80/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:30 /30Days |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in IA cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DIPHTHERIA-TETANUS TOXOIDS-PED ![Compare how all Medicare Part D PDP plans in IA cover DIPHTHERIA-TETANUS TOXOIDS-PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DISOPYRAMIDE PHOSPHATE CAPSULES 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in IA cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in IA cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in IA cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DIURIL SODIUM 500 MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover DIURIL SODIUM 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DIVALPROEX SODIUM 125 MG CAP ![Compare how all Medicare Part D PDP plans in IA cover DIVALPROEX SODIUM 125 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in IA cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover DIVALPROEX SODIUM EXTENDED RELEASE TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover DIVALPROEX SODIUM TABLETS EXTENDED RELEASE 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOCEFREZ 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in IA cover DOCEFREZ 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOCEFREZ 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in IA cover DOCEFREZ 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
Docetaxel 10mg/mL 1 VIAL, MULTI-DOSE per CARTON / 8 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in IA cover Docetaxel 10mg/mL 1 VIAL, MULTI-DOSE per CARTON / 8 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Docetaxel 80mg/4mL 1 VIAL, GLASS per CARTON / 4 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in IA cover Docetaxel 80mg/4mL 1 VIAL, GLASS per CARTON / 4 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DOLOPHINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DOLOPHINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:240 /30Days |
DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:480 /30Days |
DONEPEZIL HYDROCHLORIDE 10 MG TABLETS ![Compare how all Medicare Part D PDP plans in IA cover DONEPEZIL HYDROCHLORIDE 10 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:60 /30Days |
Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IA cover Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HYDROCHLORIDE 5 MG TABLETS ![Compare how all Medicare Part D PDP plans in IA cover DONEPEZIL HYDROCHLORIDE 5 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days |
Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IA cover Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days |
DORIBAX 500 MG VIAL ![Compare how all Medicare Part D PDP plans in IA cover DORIBAX 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in IA cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | Q:10 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 IA 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 |
$10.00 | $0.00 | Q:10 /30Days |
Doxazosin 2mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Doxazosin 2mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in IA cover DOXAZOSIN MESYLATE TABLETS 8 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in IA cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in IA cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
Doxepin Hydrochloride 50mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in IA cover Doxepin Hydrochloride 50mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in IA cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | P |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in IA cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | P |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IA cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | P |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IA cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | P |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IA cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | P |
Doxercalciferol 4 mcg/2 ml amp [HECTOROL] ![Compare how all Medicare Part D PDP plans in IA cover Doxercalciferol 4 mcg/2 ml amp [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | P |
DOXIL 2mg/mL ![Compare how all Medicare Part D PDP plans in IA cover DOXIL 2mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Doxorubicin Hydrochloride 2mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 25 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in IA cover Doxorubicin Hydrochloride 2mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 25 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IA 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 |
$10.00 | $0.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in IA cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | 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 IA cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Doxycycline 75mg/1 ![Compare how all Medicare Part D PDP plans in IA cover Doxycycline 75mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days |
Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA cover Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Doxycycline Hyclate 100mg/1 50 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 50 CAPSULE BOTTLE, PLAST ![Compare how all Medicare Part D PDP plans in IA cover Doxycycline Hyclate 100mg/1 50 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / 50 CAPSULE BOTTLE, PLAST.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IA cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IA cover Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Non-Preferred Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE TABLETS 150MG 30 BOT ![Compare how all Medicare Part D PDP plans in IA cover DOXYCYCLINE TABLETS 150MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in IA cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in IA cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:120 /30Days |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in IA cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P Q:120 /30Days |
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 IA cover DROSPIRENONE-ETH ESTRADIOL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DUETACT 30MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DUETACT 30MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DUETACT 30MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in IA cover DUETACT 30MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in IA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:13 /30Days |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in IA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:13 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in IA cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in IA cover DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in IA cover DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUONEB INHALATION SOLUTION 3-.5MG 60 X 3ML CRTN ![Compare how all Medicare Part D PDP plans in IA cover DUONEB INHALATION SOLUTION 3-.5MG 60 X 3ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P |
duramorph 0.5 mg/ml ampule ![Compare how all Medicare Part D PDP plans in IA cover duramorph 0.5 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:7200 /30Days |
duramorph 1 mg/ml ampule ![Compare how all Medicare Part D PDP plans in IA cover duramorph 1 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:3600 /30Days |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in IA cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | None |
DYMISTA NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IA cover DYMISTA NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:23 /28Days |
DYRENIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DYRENIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |
DYRENIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IA cover DYRENIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None |