2016 Medicare Part D Plan Formulary Information |
Security Blue HMO ValueRx (HMO) (H3957-031-0)
Benefit Details
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The Security Blue HMO ValueRx (HMO) (H3957-031-0) Formulary Drugs Starting with the Letter D in Lawrence County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $59.50 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 PA cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DACOGEN 50MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in PA cover DACOGEN 50MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DAKLINZA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAKLINZA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
DAKLINZA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAKLINZA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
DAKLINZA 90 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAKLINZA 90 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:28 /28Days |
DALIRESP 500 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DALIRESP 500 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DALVANCE 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover DALVANCE 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DANAZOL 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in PA cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DAPSONE TABLETS 25MG 30 BLPK ![Compare how all Medicare Part D PDP plans in PA cover DAPSONE TABLETS 25MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in PA cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DARAPRIM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DARAPRIM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DARIFENACIN ER 15 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in PA cover DARIFENACIN ER 15 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DARIFENACIN ER 7.5 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in PA cover DARIFENACIN ER 7.5 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DARZALEX 100 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DARZALEX 100 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAYTRANA PATCH 1.1 MG/HR ![Compare how all Medicare Part D PDP plans in PA cover DAYTRANA PATCH 1.1 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DAYTRANA PATCH 1.6 MG/HR ![Compare how all Medicare Part D PDP plans in PA cover DAYTRANA PATCH 1.6 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DAYTRANA PATCH 2.2 MG/HR ![Compare how all Medicare Part D PDP plans in PA cover DAYTRANA PATCH 2.2 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DAYTRANA PATCH 3.3 MG/HR ![Compare how all Medicare Part D PDP plans in PA cover DAYTRANA PATCH 3.3 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DDAVP 10 MCG/0.1 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DDAVP 10 MCG/0.1 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Decitabine 50 mg vial [Dacogen] ![Compare how all Medicare Part D PDP plans in PA cover Decitabine 50 mg vial [Dacogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DELZICOL DR 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DELZICOL DR 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DEMECLOCYCLINE HCL 150MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEMECLOCYCLINE HCL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEMECLOCYCLINE HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEMECLOCYCLINE HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 PA 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 |
45% | 45% | None |
DEPAKENE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DEPAKENE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Depakene 250mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Depakene 250mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE 125MG SPRINKLE CAP ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE 125MG SPRINKLE CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE 125MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE 125MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE 250MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE 250MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE 500MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE 500MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE ER 250MG TABLET SA ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE ER 250MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPAKOTE ER 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEPAKOTE ER 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in PA cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEPO-MEDROL 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-MEDROL 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPO-MEDROL 40MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-MEDROL 40MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPO-MEDROL 80MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-MEDROL 80MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEPO-TESTOSTERONE 100MG/ML ![Compare how all Medicare Part D PDP plans in PA cover DEPO-TESTOSTERONE 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P |
DEPO-TESTOSTERONE 200MG/ML ![Compare how all Medicare Part D PDP plans in PA cover DEPO-TESTOSTERONE 200MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESLORATADINE 2.5 MG ODDT ![Compare how all Medicare Part D PDP plans in PA cover DESLORATADINE 2.5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESLORATADINE 5 MG ODDT ![Compare how all Medicare Part D PDP plans in PA cover DESLORATADINE 5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESMOPRESSIN AC 4MCG/ML VL ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN AC 4MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESMOPRESSIN ACETATE 0.1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE 0.1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE TABLET 0.2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DESONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in PA cover DESONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover DESONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Desonide 0.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover DESONIDE 0.5mg/g 114.1 g in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
desoximetasone 0.05% ointment ![Compare how all Medicare Part D PDP plans in PA cover desoximetasone 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
Desoximetasone 2.5mg/g 1 TUBE in 1 TUBE / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
Desoximetasone 2.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DESVENLAFAXINE ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DESVENLAFAXINE ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P |
DESVENLAFAXINE ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DESVENLAFAXINE ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
Dexamethasone 10 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Dexamethasone 10 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dexedrine 10 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Dexedrine 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dexedrine 5 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Dexedrine 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE ER 15 MG CP ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE ER 15 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dexmethylphenidate er 20 mg cp ![Compare how all Medicare Part D PDP plans in PA cover Dexmethylphenidate er 20 mg cp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE ER 30 MG CP ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE ER 30 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE ER 40 MG CP ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE ER 40 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dexrazoxane 500 MG Vial ![Compare how all Medicare Part D PDP plans in PA cover Dexrazoxane 500 MG Vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROAMP-AMPHET ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMP-AMPHET ER 15 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 15 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMP-AMPHET ER 20 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMP-AMPHET ER 25 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMP-AMPHET ER 30 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 30 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMP-AMPHET ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHET ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:31 /31Days |
DEXTROAMPHETAMINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROAMPHETAMINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | Q:62 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE SULFATE CAPSULES EXTENDED RELEASED 15MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASE 5MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE SULFATE CAPSULES SUSTAINED RELEASED 10MG 100 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE 10g/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTAINER ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dextrose 5%-lr iv solution ![Compare how all Medicare Part D PDP plans in PA cover Dextrose 5%-lr iv solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Dextrose 5%-ns iv solution ![Compare how all Medicare Part D PDP plans in PA cover Dextrose 5%-ns iv solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | 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 PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DEXTROSE INJECTION USP 5 4 X 100ML CTR ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE INJECTION USP 5 4 X 100ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIASTAT 2.5 MG PEDI SYSTEM ![Compare how all Medicare Part D PDP plans in PA cover DIASTAT 2.5 MG PEDI SYSTEM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DIASTAT ACUDIAL 12.5-15-20 MG ![Compare how all Medicare Part D PDP plans in PA cover DIASTAT ACUDIAL 12.5-15-20 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DIASTAT ACUDIAL 5-7.5-10 MG KT ![Compare how all Medicare Part D PDP plans in PA cover DIASTAT ACUDIAL 5-7.5-10 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Diazepam 10mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | None |
Diazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Diazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diazepam 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Diazepam 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Diazepam 5mg/5mL 500 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Diazepam Intensol 5mg/mL 1 BOTTLE, DROPPER per CARTON / 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DIBENZYLINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DIBENZYLINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DICLOFENAC 25MG TABLET EC ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC 25MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DICLOFENAC POTASSIUM 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC POTASSIUM 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DICLOFENAC SODIUM 0.1% DROPS ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SODIUM 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
Diclofenac sodium 1.5% soln ![Compare how all Medicare Part D PDP plans in PA cover Diclofenac sodium 1.5% soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Diclofenac Sodium 1% gel ![Compare how all Medicare Part D PDP plans in PA cover Diclofenac Sodium 1% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Diclofenac Sodium 100mg/1 100 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA 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 |
$3.00 | $7.50 | None |
Diclofenac Sodium 3% gel ![Compare how all Medicare Part D PDP plans in PA cover Diclofenac Sodium 3% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SODIUM 50MG TABLET DELAYED RELEASE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
Diclofenac Sodium 75mg/1 1000 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA 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 |
$3.00 | $7.50 | None |
diclofenac-misoprost 50-0.2 tablet ![Compare how all Medicare Part D PDP plans in PA cover diclofenac-misoprost 50-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
diclofenac-misoprost 75-0.2 tablet ![Compare how all Medicare Part D PDP plans in PA cover diclofenac-misoprost 75-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICYCLOMINE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICYCLOMINE 20 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE 20 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DICYCLOMINE HCL 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE HCL 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Didanosine 200mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Didanosine 250mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIDANOSINE 400MG CAPSULE DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover DIDANOSINE 400MG CAPSULE DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover DIDANOSINE DELAYED RELEASE CAPSULES 125MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIFFERIN LOTION ![Compare how all Medicare Part D PDP plans in PA cover DIFFERIN LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA 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% | N/A | None |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIFLUNISAL 500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIFLUNISAL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Digitek 125 mcg tablet ![Compare how all Medicare Part D PDP plans in PA cover Digitek 125 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | P |
Digitek 250 mcg tablet ![Compare how all Medicare Part D PDP plans in PA cover Digitek 250 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in PA cover Digoxin 0.05mg/mL 60 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Digoxin 125ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Digoxin 125ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | P |
Digoxin 250ug 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Digoxin 250ug 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DIGOXIN INJECTION 500MCG 25 X 2ML AMP ![Compare how all Medicare Part D PDP plans in PA cover DIGOXIN INJECTION 500MCG 25 X 2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DIHYDROERGOTAMINE 1 MG/ML AM ![Compare how all Medicare Part D PDP plans in PA cover DIHYDROERGOTAMINE 1 MG/ML AM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in PA cover DIHYDROERGOTAMINE 4 MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN-125 SUS 125/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DILAUDID HYDROMORPHONE HCL ORAL LIQUID 1MG/ML 1 PINT BOTGL ![Compare how all Medicare Part D PDP plans in PA 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 |
45% | 45% | P Q:1550 /31Days |
DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT ![Compare how all Medicare Part D PDP plans in PA cover DILAUDID HYDROMORPHONE HCL TABLETS 2MG 100 TABS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:186 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in PA cover DILAUDID HYDROMORPHONE HCL TABLETS 4MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:186 /31Days |
DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT ![Compare how all Medicare Part D PDP plans in PA cover DILAUDID HYDROMORPHONE HCL TABLETS 8MG 100 TAB BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:186 /31Days |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE ![Compare how all Medicare Part D PDP plans in PA cover DILT-XR 180MG CAPSULE DEGRADABLE CONTROLLED-RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM 24HR ER 120 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 120 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM 24HR ER 240 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 240 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM 25 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 25 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM 90 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 90 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM ER 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM ER 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | 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 PA cover DILTIAZEM HCL 120MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 180 MG ER 500 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 180 MG ER 500 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 300 MG ER 90 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 300 MG ER 90 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 360 MG ER CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 360 MG ER CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 420 MG ER CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 420 MG ER CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 60 MG ER CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 60 MG ER CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 60 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DILTIAZEM HCL 90 MG ER CAPSULES 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM HCL 90 MG ER CAPSULES 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DIPENTUM 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DIPENTUM 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
diphenhydramine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover diphenhydramine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in PA cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIPHTHERIA-TETANUS TOXOIDS-PED ![Compare how all Medicare Part D PDP plans in PA cover DIPHTHERIA-TETANUS TOXOIDS-PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Disulfiram 250mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Disulfiram 250mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Disulfiram 500mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Disulfiram 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in PA cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DIVALPROEX SODIUM 125 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SODIUM 125 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIVALPROEX SODIUM 125MG TBEC ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SODIUM 125MG TBEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Divalproex Sodium 250mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Divalproex Sodium 500mg/1 500 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIVALPROEX SODIUM TABLETS ER 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SODIUM TABLETS ER 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DIVIGEL 0.5 MG GEL PACKET ![Compare how all Medicare Part D PDP plans in PA cover DIVIGEL 0.5 MG GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DOCEFREZ 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in PA cover DOCEFREZ 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | 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 PA 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 |
Generic |
$15.00 | $37.50 | None |
Docetaxel 80mg/4mL 1 VIAL, GLASS per CARTON / 4 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | None |
DOLOPHINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOLOPHINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:206 /31Days |
DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:248 /31Days |
Dolutegravir 25 mg oral tablet [TIVICAY] ![Compare how all Medicare Part D PDP plans in PA cover Dolutegravir 25 mg oral tablet [TIVICAY].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DONEPEZIL HCL 23 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL 23 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Donepezil Hydrochloride 10mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in PA cover Donepezil Hydrochloride 5mg/1 30 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DORIBAX 500 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover DORIBAX 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | None |
Doxazosin 2mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Doxazosin 2mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DOXAZOSIN MESYLATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DOXAZOSIN MESYLATE TABLETS 8 MG ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE TABLETS 8 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DOXAZOSIN TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DOXEPIN 10 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 10 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXEPIN 5% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | P |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Doxercalciferol 4 mcg/2 ml amp [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 4 mcg/2 ml amp [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxorubicin Hydrochloride 10 ml Liposome 2 mg/ml injection ![Compare how all Medicare Part D PDP plans in PA cover Doxorubicin Hydrochloride 10 ml Liposome 2 mg/ml injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | P |
Doxorubicin liposome 20mg/10ml ![Compare how all Medicare Part D PDP plans in PA cover Doxorubicin liposome 20mg/10ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
Doxy 100 vial ![Compare how all Medicare Part D PDP plans in PA cover Doxy 100 vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline 100mg/1 50 TABLET, COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in PA cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline 75mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline 75mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline hyc 100 mg vial ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline hyc 100 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline hyc dr 200 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline hyc dr 200 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxycycline hyc dr 200 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline hyc dr 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline hyc dr 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline hyc dr 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline Hyclate 100mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA 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 |
Generic |
$15.00 | $37.50 | 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 PA 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 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
Doxycycline Hyclate 75mg/1 60 TABLET, DELAYED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA 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 |
$3.00 | $7.50 | None |
DOXYCYCLINE HYCLATE TAB 150MG ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE TAB 150MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $7.50 | None |
DOXYCYCLINE MONO 100 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE MONO 50 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONOHYDRATE 75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONOHYDRATE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
Doxycycline Monohydrate IR 150mg/1 60 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Doxycycline Monohydrate IR 150mg/1 60 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DOXYCYCLINE TABLETS 150MG 30 BOT ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE TABLETS 150MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P |
DROSPIRENONE-EE 3-0.02 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DROSPIRENONE-EE 3-0.02 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DROSPIRENONE-ETH ESTRADIOL TAB ![Compare how all Medicare Part D PDP plans in PA cover DROSPIRENONE-ETH ESTRADIOL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUEXIS 26.6; 800mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in PA cover DUEXIS 26.6; 800mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in PA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | Q:13 /30Days |
DULERA INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in PA cover DULERA INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | Q:13 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:62 /31Days |
DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:31 /31Days |
DULOXETINE HCL DR 40 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 40 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:31 /31Days |
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:62 /31Days |
DUOPA 4.63 MG-20 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover DUOPA 4.63 MG-20 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | 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 PA 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 |
45% | 45% | P Q:20 /30Days |
DURAGESIC PATCH 100 MCG/HR ![Compare how all Medicare Part D PDP plans in PA cover DURAGESIC PATCH 100 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:10 /30Days |
DURAGESIC PATCH 12.5 MCG/HR ![Compare how all Medicare Part D PDP plans in PA cover DURAGESIC PATCH 12.5 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | 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 PA cover DURAGESIC PATCH 50 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:17 /30Days |
DURAGESIC PATCH 75 MCG/HR ![Compare how all Medicare Part D PDP plans in PA cover DURAGESIC PATCH 75 MCG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P Q:12 /30Days |
duramorph 0.5 mg/ml ampule ![Compare how all Medicare Part D PDP plans in PA cover duramorph 0.5 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P Q:4000 /30Days |
duramorph 1 mg/ml ampule ![Compare how all Medicare Part D PDP plans in PA cover duramorph 1 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $37.50 | P Q:2000 /30Days |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DUTASTERIDE 0.5 MG CAPSULE [Avodart] ![Compare how all Medicare Part D PDP plans in PA cover DUTASTERIDE 0.5 MG CAPSULE [Avodart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 [JALYN] ![Compare how all Medicare Part D PDP plans in PA cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 [JALYN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
DYMISTA NASAL SPRAY ![Compare how all Medicare Part D PDP plans in PA cover DYMISTA NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DYRENIUM 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DYRENIUM 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | None |
DYRENIUM 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DYRENIUM 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | 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 PA 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 |
45% | 45% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DYSPORT 500 UNITS VIAL ![Compare how all Medicare Part D PDP plans in PA cover DYSPORT 500 UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
45% | 45% | P |