2015 Medicare Part D Plan Formulary Information |
Freedom Blue PPO ValueRx (PPO) (H5106-027-0)
Benefit Details
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The Freedom Blue PPO ValueRx (PPO) (H5106-027-0) Formulary Drugs Starting with the Letter D in MONONGALIA County, WV: CMS MA Region 6 which includes: WV Plan Monthly Premium: $75.00 Deductible: $0 |
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 WV cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DACOGEN 50MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in WV cover DACOGEN 50MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DALVANCE 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover DALVANCE 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in WV cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in WV cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in WV 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 | $237.50 | None |
DARAPRIM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DARAPRIM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DAUNOXOME 50 MG (2 MG/ML) VIAL ![Compare how all Medicare Part D PDP plans in WV cover DAUNOXOME 50 MG (2 MG/ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DAYTRANA PATCH 1.1 MG/HR ![Compare how all Medicare Part D PDP plans in WV cover DAYTRANA PATCH 1.1 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DAYTRANA PATCH 1.6 MG/HR ![Compare how all Medicare Part D PDP plans in WV cover DAYTRANA PATCH 1.6 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DAYTRANA PATCH 2.2 MG/HR ![Compare how all Medicare Part D PDP plans in WV cover DAYTRANA PATCH 2.2 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DAYTRANA PATCH 3.3 MG/HR ![Compare how all Medicare Part D PDP plans in WV cover DAYTRANA PATCH 3.3 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DDAVP 0.01% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover DDAVP 0.01% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DDAVP 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DDAVP 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DDAVP 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DDAVP 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DDAVP 10 MCG/0.1 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover DDAVP 10 MCG/0.1 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DDAVP 4 MCG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WV cover DDAVP 4 MCG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Decitabine 50 mg vial [Dacogen] ![Compare how all Medicare Part D PDP plans in WV cover Decitabine 50 mg vial [Dacogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DELZICOL DR 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DELZICOL DR 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DEMECLOCYCLINE HCL 150MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEMECLOCYCLINE HCL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEMECLOCYCLINE HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEMECLOCYCLINE HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in WV cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | 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 WV 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 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEPAKENE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DEPAKENE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Depakene 250mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 | $237.50 | None |
DEPAKOTE 125MG SPRINKLE CAP ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE 125MG SPRINKLE CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPAKOTE 125MG TABLET EC ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE 125MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPAKOTE 250MG TABLET EC ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE 250MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPAKOTE 500MG TABLET EC ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE 500MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPAKOTE ER 250MG TABLET SA ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE ER 250MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPAKOTE ER 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEPAKOTE ER 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in WV cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPO-MEDROL 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-MEDROL 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEPO-MEDROL 40MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-MEDROL 40MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPO-MEDROL 80MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-MEDROL 80MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPO-PROVERA 150MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-PROVERA 150MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WV 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 | $237.50 | None |
DEPO-TESTOSTERONE 100MG/ML ![Compare how all Medicare Part D PDP plans in WV cover DEPO-TESTOSTERONE 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DEPO-TESTOSTERONE 200MG/ML ![Compare how all Medicare Part D PDP plans in WV cover DEPO-TESTOSTERONE 200MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DERMATOP 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WV cover DERMATOP 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DERMATOP 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover DERMATOP 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESLORATADINE 2.5 MG ODDT ![Compare how all Medicare Part D PDP plans in WV cover DESLORATADINE 2.5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESLORATADINE 5 MG ODDT ![Compare how all Medicare Part D PDP plans in WV cover DESLORATADINE 5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in WV cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Desmopressin Acetate 0.1mg/mL 1 VIAL in 1 CARTON / 2.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WV cover Desmopressin Acetate 0.1mg/mL 1 VIAL in 1 CARTON / 2.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in WV cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in WV cover DESONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DESONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover DESONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DesOwen 0.5mg/g 118 g in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DesOwen 0.5mg/g 118 g in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DesOwen 0.5mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV cover DesOwen 0.5mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
desoximetasone 0.05% ointment ![Compare how all Medicare Part D PDP plans in WV cover desoximetasone 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | 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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DESOXYN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DESOXYN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DESVENLAFAXINE ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover DESVENLAFAXINE ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DESVENLAFAXINE ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover DESVENLAFAXINE ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXAMETHASONE 1.5 MGTABLETS ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 1.5 MGTABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Dexamethasone 10 mg/ml vial ![Compare how all Medicare Part D PDP plans in WV cover Dexamethasone 10 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE SODIUM PHOSPHATE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in WV cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Dexedrine 10 mg tablet ![Compare how all Medicare Part D PDP plans in WV cover Dexedrine 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXEDRINE 10mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover DEXEDRINE 10mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DEXEDRINE 15mg 90 BOTTLE per CARTON / 90 CAPSULE, ER in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DEXEDRINE 15mg 90 BOTTLE per CARTON / 90 CAPSULE, ER in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Dexedrine 5 mg tablet ![Compare how all Medicare Part D PDP plans in WV cover Dexedrine 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXEDRINE 5mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover DEXEDRINE 5mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE ER 15 MG CP ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE ER 15 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Dexmethylphenidate er 20 mg cp ![Compare how all Medicare Part D PDP plans in WV cover Dexmethylphenidate er 20 mg cp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE ER 30 MG CP ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE ER 30 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE ER 40 MG CP ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE ER 40 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Dexrazoxane 500 MG Vial ![Compare how all Medicare Part D PDP plans in WV cover Dexrazoxane 500 MG Vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMP-AMPHET ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHET ER 15 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 15 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMP-AMPHET ER 20 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMP-AMPHET ER 25 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMP-AMPHET ER 30 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 30 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMP-AMPHET ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMP-AMPHET ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE 10g/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTAINER ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 10g/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTAINER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE 5%-LR IV SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 5%-LR IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE 5%-NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE 5%-NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in WV cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIAMOX SEQUELS 500MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WV cover DIAMOX SEQUELS 500MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIASTAT 2.5 MG PEDI SYSTEM ![Compare how all Medicare Part D PDP plans in WV cover DIASTAT 2.5 MG PEDI SYSTEM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIASTAT ACUDIAL 12.5-15-20 MG ![Compare how all Medicare Part D PDP plans in WV cover DIASTAT ACUDIAL 12.5-15-20 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIASTAT ACUDIAL 5-7.5-10 MG KT ![Compare how all Medicare Part D PDP plans in WV cover DIASTAT ACUDIAL 5-7.5-10 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | 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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | 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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | 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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Diazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Diazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Diazepam 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Diazepam 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIBENZYLINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DIBENZYLINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in WV cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in WV cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Diclofenac sodium 1.5% soln ![Compare how all Medicare Part D PDP plans in WV cover Diclofenac sodium 1.5% soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Diclofenac Sodium 3% gel ![Compare how all Medicare Part D PDP plans in WV cover Diclofenac Sodium 3% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$4.00 | $10.00 | None |
diclofenac-misoprost 50-0.2 tablet ![Compare how all Medicare Part D PDP plans in WV cover diclofenac-misoprost 50-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
diclofenac-misoprost 75-0.2 tablet ![Compare how all Medicare Part D PDP plans in WV cover diclofenac-misoprost 75-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WV cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WV cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in WV cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in WV cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIFFERIN 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WV cover DIFFERIN 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFFERIN 0.1% GEL ![Compare how all Medicare Part D PDP plans in WV cover DIFFERIN 0.1% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFFERIN 3mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV cover DIFFERIN 3mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFFERIN LOTION ![Compare how all Medicare Part D PDP plans in WV cover DIFFERIN LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WV cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIFLUCAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFLUCAN 150MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFLUCAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFLUCAN 200MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 200MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFLUCAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFLUCAN 50MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in WV cover DIFLUCAN 50MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIFLUNISAL 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Digitek 125 mcg tablet ![Compare how all Medicare Part D PDP plans in WV cover Digitek 125 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | P |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | P |
Digoxin 125ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Digoxin 125ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | P |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in WV cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DIHYDROERGOTAMINE 1 MG/ML AM ![Compare how all Medicare Part D PDP plans in WV cover DIHYDROERGOTAMINE 1 MG/ML AM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in WV cover DIHYDROERGOTAMINE 4 MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in WV cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in WV cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV 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 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in WV cover DILANTIN-125 SUS 125/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DILAUDID HP HYDROMORPHONE HCL INJECTION 10MG/ML ML VIALSD ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HP HYDROMORPHONE HCL INJECTION 10MG/ML ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DILAUDID HYDROMORPHONE HCL INJECTION 2MG/ML 10 AMP BOX ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HYDROMORPHONE HCL INJECTION 2MG/ML 10 AMP BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DILAUDID HYDROMORPHONE HCL INJECTION 4MG/ML 10 AMP BOX ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HYDROMORPHONE HCL INJECTION 4MG/ML 10 AMP BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL ![Compare how all Medicare Part D PDP plans in WV 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 |
$95.00 | $237.50 | P Q:2480 /31Days |
DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in WV cover DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:186 /31Days |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in WV cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM 24HR ER 120 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM 24HR ER 120 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24HR ER 240 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM 24HR ER 240 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM 25 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM 25 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM 90 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM 90 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 120MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 180 MG ER 500 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 180 MG ER 500 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 300 MG ER 90 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 300 MG ER 90 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 360 MG ER CAPSULES ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 360 MG ER CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM HCL 420 MG ER CAPSULES ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 420 MG ER CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 60 MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 60 MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DILTIAZEM HCL 90 MG ER CAPSULES 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DILTIAZEM HCL 90 MG ER CAPSULES 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DIPENTUM 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DIPENTUM 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
diphenhydramine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in WV cover diphenhydramine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in WV cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIPHTHERIA-TETANUS TOXOIDS-PED ![Compare how all Medicare Part D PDP plans in WV cover DIPHTHERIA-TETANUS TOXOIDS-PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIPROLENE 0.05% LOTION ![Compare how all Medicare Part D PDP plans in WV cover DIPROLENE 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIPROLENE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover DIPROLENE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIPROLENE AF 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WV cover DIPROLENE AF 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in WV cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in WV cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in WV cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DIURIL SODIUM 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover DIURIL SODIUM 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DIVALPROEX SODIUM 125 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DIVALPROEX SODIUM 125 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in WV cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV 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 |
$12.00 | $30.00 | None |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DIVALPROEX SODIUM TABLETS ER 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover DIVALPROEX SODIUM TABLETS ER 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIVIGEL 0.5 MG GEL PACKET ![Compare how all Medicare Part D PDP plans in WV cover DIVIGEL 0.5 MG GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DOCEFREZ 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WV cover DOCEFREZ 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Docetaxel 80mg/4mL 1 VIAL, GLASS per CARTON / 4 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOLOPHINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DOLOPHINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:248 /31Days |
DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:248 /31Days |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DONEPEZIL HCL 23 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DONEPEZIL HCL 23 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WV cover Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WV cover Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DORIBAX 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover DORIBAX 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in WV cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | 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 WV 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 |
$12.00 | $30.00 | None |
Doxazosin 2mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Doxazosin 2mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in WV cover DOXAZOSIN MESYLATE TABLETS 8 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DOXEPIN 10MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in WV cover DOXEPIN 10MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | 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 WV 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 |
$12.00 | $30.00 | P |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in WV cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in WV cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in WV cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in WV cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Doxercalciferol 4 mcg/2 ml amp [HECTOROL] ![Compare how all Medicare Part D PDP plans in WV cover Doxercalciferol 4 mcg/2 ml amp [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DOXIL 2mg/mL ![Compare how all Medicare Part D PDP plans in WV cover DOXIL 2mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
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 WV 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) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
Doxy 100 vial ![Compare how all Medicare Part D PDP plans in WV cover Doxy 100 vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in WV cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXYCYCLINE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Doxycycline 75mg/1 ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline 75mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Doxycycline hyc 100 mg vial ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline hyc 100 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | 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 WV 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) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
DOXYCYCLINE HYCLATE TAB 150MG ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE HYCLATE TAB 150MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 100 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE MONO 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE MONO 50 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE MONO 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Doxycycline Monohydrate IR 150mg/1 60 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Doxycycline Monohydrate IR 150mg/1 60 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DOXYCYCLINE TABLETS 150MG 30 BOT ![Compare how all Medicare Part D PDP plans in WV cover DOXYCYCLINE TABLETS 150MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in WV cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in WV cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in WV cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DROSPIRENONE-ETH ESTRADIOL TAB ![Compare how all Medicare Part D PDP plans in WV cover DROSPIRENONE-ETH ESTRADIOL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DUEXIS 26.6; 800mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in WV cover DUEXIS 26.6; 800mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in WV cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in WV cover DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in WV cover DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None |
DUOPA 4.63 MG-20 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WV cover DUOPA 4.63 MG-20 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |
DURAGESIC 25ug/h 5 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 72 h in 1 PATCH ![Compare how all Medicare Part D PDP plans in WV cover DURAGESIC 25ug/h 5 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 72 h in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:20 /30Days |
DURAGESIC PATCH 100 MCG/HR ![Compare how all Medicare Part D PDP plans in WV cover DURAGESIC PATCH 100 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:20 /30Days |
DURAGESIC PATCH 12.5 MCG/HR ![Compare how all Medicare Part D PDP plans in WV cover DURAGESIC PATCH 12.5 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:20 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DURAGESIC PATCH 50 MCG/HR ![Compare how all Medicare Part D PDP plans in WV cover DURAGESIC PATCH 50 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:20 /30Days |
DURAGESIC PATCH 75 MCG/HR ![Compare how all Medicare Part D PDP plans in WV cover DURAGESIC PATCH 75 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P Q:20 /30Days |
duramorph 0.5 mg/ml ampule ![Compare how all Medicare Part D PDP plans in WV cover duramorph 0.5 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
duramorph 1 mg/ml ampule ![Compare how all Medicare Part D PDP plans in WV cover duramorph 1 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | P |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in WV cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DYMISTA NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WV cover DYMISTA NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None |
DYRENIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DYRENIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
DYRENIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover DYRENIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $112.50 | None |
Dysport 3001/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WV cover Dysport 3001/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | P |