2017 Medicare Part D Plan Formulary Information |
Humana Preferred Rx Plan (PDP) (S5884-145-0)
Benefit Details
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The Humana Preferred Rx Plan (PDP) (S5884-145-0) Formulary Drugs Starting with the Letter L in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY Plan Monthly Premium: $26.70 Deductible: $400 Qualifies for LIS: Yes |
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LABETALOL HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LABETALOL HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LABETALOL HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LABETALOL HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LABETALOL HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LABETALOL HCL 5MG/20ML VIAL ![Compare how all Medicare Part D PDP plans in NE cover LABETALOL HCL 5MG/20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LACTATED RINGERS INJECTION ![Compare how all Medicare Part D PDP plans in NE cover LACTATED RINGERS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LACTATED RINGERS IRRIGATION 4 CONTAINER in 1 CASE / 40 ![Compare how all Medicare Part D PDP plans in NE cover LACTATED RINGERS IRRIGATION 4 CONTAINER in 1 CASE / 40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LACTULOSE SOLUTION ORAL 10GM/15ML 946ML BOT ![Compare how all Medicare Part D PDP plans in NE cover LACTULOSE SOLUTION ORAL 10GM/15ML 946ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lamivudine 10 mg/ml oral soln ![Compare how all Medicare Part D PDP plans in NE cover Lamivudine 10 mg/ml oral soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:960 /30Days |
LAMIVUDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LAMIVUDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:60 /30Days |
LAMIVUDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LAMIVUDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lamivudine hbv 100 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover Lamivudine hbv 100 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LAMIVUDINE-ZIDOVUDINE TABLET ![Compare how all Medicare Part D PDP plans in NE cover LAMIVUDINE-ZIDOVUDINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:60 /30Days |
LAMOTRIGINE 150MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE 150MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 25MG TABLET DISPERSIBLE ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE 25MG TABLET DISPERSIBLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 5MG TABLET DISPERSIBLE ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE 5MG TABLET DISPERSIBLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
lamotrigine er 200 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover lamotrigine er 200 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
lamotrigine er 25 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover lamotrigine er 25 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
lamotrigine er 250 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover lamotrigine er 250 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
lamotrigine er 300 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover lamotrigine er 300 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
lamotrigine er 50 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover lamotrigine er 50 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Lamotrigine ODT 100 MG Tablet ![Compare how all Medicare Part D PDP plans in NE cover Lamotrigine ODT 100 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Lamotrigine ODT 200 MG Tablet ![Compare how all Medicare Part D PDP plans in NE cover Lamotrigine ODT 200 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Lamotrigine ODT 25 MG Tablet ![Compare how all Medicare Part D PDP plans in NE cover Lamotrigine ODT 25 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Lamotrigine ODT 50 MG Tablet ![Compare how all Medicare Part D PDP plans in NE cover Lamotrigine ODT 50 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LAMOTRIGINE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LAMOTRIGINE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LANOXIN 0.25 MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in NE cover LANOXIN 0.25 MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LANOXIN 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LANOXIN 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:30 /30Days |
LANOXIN 187.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LANOXIN 187.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:30 /30Days |
LANOXIN 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LANOXIN 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANOXIN 62.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LANOXIN 62.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:30 /30Days |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in NE cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in NE cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LARIN 21 1-20 tablet ![Compare how all Medicare Part D PDP plans in NE cover LARIN 21 1-20 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in NE cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in NE cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Larissia-28 tablet ![Compare how all Medicare Part D PDP plans in NE cover Larissia-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LARTRUVO 500 MG/50 ML VIAL ![Compare how all Medicare Part D PDP plans in NE cover LARTRUVO 500 MG/50 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in NE cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:5 /25Days |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:30 /30Days |
Latuda 40mg/1 ![Compare how all Medicare Part D PDP plans in NE cover Latuda 40mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:30 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:30 /30Days |
Latuda 80mg/1 ![Compare how all Medicare Part D PDP plans in NE cover Latuda 80mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:60 /30Days |
LAZANDA 100 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in NE cover LAZANDA 100 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LAZANDA 300 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in NE cover LAZANDA 300 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LAZANDA 400 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in NE cover LAZANDA 400 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LEFLUNOMIDE 10MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEFLUNOMIDE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:30 /30Days |
Leflunomide 20 mg tablet ![Compare how all Medicare Part D PDP plans in NE cover Leflunomide 20 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:30 /30Days |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in NE cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in NE cover Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LETAIRIS 10 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LETAIRIS 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LETAIRIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LETAIRIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LEUCOVORIN CALCIUM 100MG VL ![Compare how all Medicare Part D PDP plans in NE cover LEUCOVORIN CALCIUM 100MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Leucovorin Calcium 15mg/1 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover Leucovorin Calcium 15mg/1 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEUCOVORIN CALCIUM 25MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEUCOVORIN CALCIUM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEUCOVORIN CALCIUM 350MG VL ![Compare how all Medicare Part D PDP plans in NE cover LEUCOVORIN CALCIUM 350MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEUCOVORIN CALCIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEUCOVORIN CALCIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEUKINE 250 MCG VIAL ![Compare how all Medicare Part D PDP plans in NE cover LEUKINE 250 MCG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Leuprolide 2wk 1 mg/0.2 ml kit ![Compare how all Medicare Part D PDP plans in NE cover Leuprolide 2wk 1 mg/0.2 ml kit.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEVEMIR 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in NE cover LEVEMIR 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVEMIR FLEXTOUCH 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in NE cover LEVEMIR FLEXTOUCH 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Levetiracetam 100mg/mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NE cover Levetiracetam 100mg/mL 473 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM 500 MG TABLET 120 BOT ![Compare how all Medicare Part D PDP plans in NE cover LEVETIRACETAM 500 MG TABLET 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Levetiracetam 500 mg/5 ml vial ![Compare how all Medicare Part D PDP plans in NE cover Levetiracetam 500 mg/5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Levetiracetam 500mg/1 60 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NE cover Levetiracetam 500mg/1 60 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVETIRACETAM ER 750 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVETIRACETAM ER 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVETIRACETAM TABLETS 1000MG 60 BOT ![Compare how all Medicare Part D PDP plans in NE cover LEVETIRACETAM TABLETS 1000MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM TABLETS 250MG 500 BOT ![Compare how all Medicare Part D PDP plans in NE cover LEVETIRACETAM TABLETS 250MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM TABLETS 750MG 500 BOT ![Compare how all Medicare Part D PDP plans in NE cover LEVETIRACETAM TABLETS 750MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in NE cover LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOCARNITINE 1 G/10 ML SOLN ![Compare how all Medicare Part D PDP plans in NE cover LEVOCARNITINE 1 G/10 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOCETIRIZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOCETIRIZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
Levofloxacin 250mg/1 [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 250mg/1 [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Levofloxacin 25mg/mL 1 BOTTLE per CARTON / 100 mL in 1 BOTTLE [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 25mg/mL 1 BOTTLE per CARTON / 100 mL in 1 BOTTLE [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Levofloxacin 500 MG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 500 MG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOFLOXACIN 500 MG/20 ML VIAL [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover LEVOFLOXACIN 500 MG/20 ML VIAL [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Levofloxacin 5mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 5mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Levofloxacin 750 MG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover Levofloxacin 750 MG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOFLOXACIN-D5W 750 MG/150 ML [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in NE cover LEVOFLOXACIN-D5W 750 MG/150 ML [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev] ![Compare how all Medicare Part D PDP plans in NE cover LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEVONOR-ETH ESTRAD 0.1-0.02 MG ![Compare how all Medicare Part D PDP plans in NE cover LEVONOR-ETH ESTRAD 0.1-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
levonor-eth estrad 0.15-0.03 ![Compare how all Medicare Part D PDP plans in NE cover levonor-eth estrad 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in NE cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in NE cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LEVORPHANOL 2 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVORPHANOL 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:240 /30Days |
Levothyroxine 100 mcg tablet ![Compare how all Medicare Part D PDP plans in NE cover Levothyroxine 100 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Levothyroxine 25 mcg tablet ![Compare how all Medicare Part D PDP plans in NE cover Levothyroxine 25 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 150MCG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 150MCG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 75MCG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 75MCG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:1575 /28Days |
LEXIVA 700MG TABLETS ![Compare how all Medicare Part D PDP plans in NE cover LEXIVA 700MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:120 /30Days |
LIALDA 1.2G TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in NE cover LIALDA 1.2G TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:120 /30Days |
Lidocaine 2% viscous soln ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine 2% viscous soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lidocaine 5% patch ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine 5% patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | P Q:90 /30Days |
lidocaine hcl 2% jelly ![Compare how all Medicare Part D PDP plans in NE cover lidocaine hcl 2% jelly.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
lidocaine hcl 2% jelly ![Compare how all Medicare Part D PDP plans in NE cover lidocaine hcl 2% jelly.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LIDOCAINE HCL 2% JELLY 30ML TUBE ![Compare how all Medicare Part D PDP plans in NE cover LIDOCAINE HCL 2% JELLY 30ML TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lidocaine hcl 4% solution ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine hcl 4% solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lidocaine Hydrochloride 20mg/mL 25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine Hydrochloride 20mg/mL 25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lidocaine Hydrochloride 5 ML 10 MG/ML Injection ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine Hydrochloride 5 ML 10 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lidocaine Hydrochloride 5mg/mL 25 VIAL, SINGLE-DOSE in 1 CONTAINER / 50 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in NE cover Lidocaine Hydrochloride 5mg/mL 25 VIAL, SINGLE-DOSE in 1 CONTAINER / 50 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LIDOCAINE-PRILOCAINE CREAM ![Compare how all Medicare Part D PDP plans in NE cover LIDOCAINE-PRILOCAINE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Lincomycin hcl 600 mg/2 ml vl [Lincocin] ![Compare how all Medicare Part D PDP plans in NE cover Lincomycin hcl 600 mg/2 ml vl [Lincocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LINDANE SHAMPOO 1MG 2 FLO BOT ![Compare how all Medicare Part D PDP plans in NE cover LINDANE SHAMPOO 1MG 2 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Linezolid 20 MG/ML Oral Suspension [Zyvox] ![Compare how all Medicare Part D PDP plans in NE cover Linezolid 20 MG/ML Oral Suspension [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in NE cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Linezolid 600 mg/300 ml iv sol [Zyvox] ![Compare how all Medicare Part D PDP plans in NE cover Linezolid 600 mg/300 ml iv sol [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:30 /30Days |
liothyronine sodium 10ug/mL 1 VIAL per CARTON / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in NE cover liothyronine sodium 10ug/mL 1 VIAL per CARTON / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LIOTHYRONINE SODIUM TABLETS 25MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in NE cover LIOTHYRONINE SODIUM TABLETS 25MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in NE cover LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LIOTHYRONINE SODIUM TABLETS 5MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in NE cover LIOTHYRONINE SODIUM TABLETS 5MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LISINOPRIL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 30MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL 30MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LISINOPRIL 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lisinopril 5mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover Lisinopril 5mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lisinopril with Hydrochlorothiazide 12.5; 10mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NE cover Lisinopril with Hydrochlorothiazide 12.5; 10mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lisinopril with Hydrochlorothiazide 12.5; 20mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NE cover Lisinopril with Hydrochlorothiazide 12.5; 20mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LISINOPRIL-HCTZ 20-25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lithium Carbonate 150mg/1 100 CAPSULE BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NE cover Lithium Carbonate 150mg/1 100 CAPSULE BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lithium Carbonate 300 mg tab ![Compare how all Medicare Part D PDP plans in NE cover Lithium Carbonate 300 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE 300MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LITHIUM CARBONATE 300MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Lithium Carbonate 450mg/1 ![Compare how all Medicare Part D PDP plans in NE cover Lithium Carbonate 450mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE 600 MG CAP ![Compare how all Medicare Part D PDP plans in NE cover LITHIUM CARBONATE 600 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE ER TABLET 300MG (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LITHIUM CARBONATE ER TABLET 300MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in NE cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHOSTAT 250 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LITHOSTAT 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LOMEDIA 24 FE 24MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LOMEDIA 24 FE 24MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:100 /30Days |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:80 /30Days |
LOPERAMIDE HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LOPERAMIDE HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lopinavir-Ritonavir 80-20mg/ml [Kaletra] ![Compare how all Medicare Part D PDP plans in NE cover Lopinavir-Ritonavir 80-20mg/ml [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:90 /30Days |
Lorazepam 1 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover Lorazepam 1 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:90 /30Days |
Lorazepam 2 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover Lorazepam 2 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:150 /30Days |
Lorazepam 2mg/mL 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in NE cover Lorazepam 2mg/mL 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:150 /30Days |
Loryna (drospirenone and ethinyl estradiol) 3 CARTON in 1 BOX / 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in NE cover Loryna (drospirenone and ethinyl estradiol) 3 CARTON in 1 BOX / 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOSARTAN POTASSIUM 100 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN POTASSIUM 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN POTASSIUM 25 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN POTASSIUM 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN POTASSIUM 50 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN POTASSIUM 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 100-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN-HCTZ 100-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 100-25 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN-HCTZ 100-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 50-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in NE cover LOSARTAN-HCTZ 50-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
Lovastatin 10mg 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NE cover Lovastatin 10mg 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
LOVASTATIN 40 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in NE cover LOVASTATIN 40 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
Low-ogestrel-28 tablet ![Compare how all Medicare Part D PDP plans in NE cover Low-ogestrel-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LOXAPINE 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in NE cover LOXAPINE 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOXAPINE CAPSULES 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in NE cover LOXAPINE CAPSULES 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOXAPINE CAPSULES 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in NE cover LOXAPINE CAPSULES 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOXAPINE CAPSULES 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in NE cover LOXAPINE CAPSULES 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LUMIGAN 0.1mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in NE cover LUMIGAN 0.1mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | Q:3 /25Days |
Lumizyme 5mg/mL ![Compare how all Medicare Part D PDP plans in NE cover Lumizyme 5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Lutera-28 tablet ![Compare how all Medicare Part D PDP plans in NE cover Lutera-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |
LYNPARZA 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYNPARZA 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:448 /28Days |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:900 /30Days |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:60 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:60 /30Days |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in NE cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | Q:90 /30Days |
LYSODREN 500MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LYSODREN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 15% | None |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in NE cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 30% | None |