2018 Medicare Part D Plan Formulary Information |
Advantra Choice (HMO) (H1692-004-0)
Benefit Details
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The Advantra Choice (HMO) (H1692-004-0) Formulary Drugs Starting with the Letter L in Lincoln County, WV: CMS MA Region 6 which includes: WV Plan Monthly Premium: $0.00 Deductible: $0 |
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 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LABETALOL HCL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LABETALOL HCL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LABETALOL HCL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LABETALOL HCL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Labetalol hydrochloride 5 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in WV cover Labetalol hydrochloride 5 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LACTATED RINGERS INJECTION ![Compare how all Medicare Part D PDP plans in WV cover LACTATED RINGERS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LACTULOSE 10 GM/15 ML SOLUTION [Constulose] ![Compare how all Medicare Part D PDP plans in WV cover LACTULOSE 10 GM/15 ML SOLUTION [Constulose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMICTAL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 150MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 25MG DISPER TABLET CHEW ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 25MG DISPER TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMICTAL 25MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 25MG TABLET STARTER KIT ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 25MG TABLET STARTER KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 25MG/100MG TABLET STARTER KIT ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 25MG/100MG TABLET STARTER KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL 5MG DISPER TABLET CHEW ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL 5MG DISPER TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL KIT 100;25MG;MG ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL KIT 100;25MG;MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL ODT 100mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL ODT 100mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL ODT 200mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL ODT 200mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL ODT 25mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL ODT 25mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL ODT 50mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL ODT 50mg/1 30 TABLET, ORALLY DISINTEGRATING in 1 DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMICTAL XR 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR 250 MG ER 30 TABLET, FILM COATED in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 250 MG ER 30 TABLET, FILM COATED in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR 300 MG ER 30 TABLET, FILM COATED in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 300 MG ER 30 TABLET, FILM COATED in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S |
LAMICTAL XR 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR START KIT (BLUE) ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR START KIT (BLUE).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR START KIT (GREEN) ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR START KIT (GREEN).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMICTAL XR START KIT (ORANGE) ![Compare how all Medicare Part D PDP plans in WV cover LAMICTAL XR START KIT (ORANGE).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
Lamivudine 10 mg/ml oral soln ![Compare how all Medicare Part D PDP plans in WV cover Lamivudine 10 mg/ml oral soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMIVUDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMIVUDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMIVUDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMIVUDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Lamivudine hbv 100 mg tablet ![Compare how all Medicare Part D PDP plans in WV cover Lamivudine hbv 100 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMIVUDINE-ZIDOVUDINE TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMIVUDINE-ZIDOVUDINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE 150MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE 150MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMOTRIGINE 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMOTRIGINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LAMOTRIGINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE ER 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE ER 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Lamotrigine ODT 100 MG Tablet ![Compare how all Medicare Part D PDP plans in WV cover Lamotrigine ODT 100 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Lamotrigine ODT 200 MG Tablet ![Compare how all Medicare Part D PDP plans in WV cover Lamotrigine ODT 200 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Lamotrigine ODT 50 MG Tablet ![Compare how all Medicare Part D PDP plans in WV cover Lamotrigine ODT 50 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LAMOTRIGINE START KIT-BLUE TAB DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE START KIT-BLUE TAB DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMOTRIGINE START KIT-GREEN TAB DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE START KIT-GREEN TAB DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMOTRIGINE START KIT-ORANG TAB DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE START KIT-ORANG TAB DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S |
LAMOTRIGINE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover LAMOTRIGINE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LANOXIN 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LANOXIN 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LANOXIN 187.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LANOXIN 187.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANOXIN 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LANOXIN 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LANOXIN 500 MCG/2 ML AMPULE ![Compare how all Medicare Part D PDP plans in WV cover LANOXIN 500 MCG/2 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LANOXIN 62.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LANOXIN 62.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LANSOPRAZOL-AMOXICIL-CLARITHRO ![Compare how all Medicare Part D PDP plans in WV cover LANSOPRAZOL-AMOXICIL-CLARITHRO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:224 /365Days |
LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
![Compare how all Medicare Part D PDP plans in WV cover LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid] ![Compare how all Medicare Part D PDP plans in WV cover LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LANSOPRAZOLE ODT 15 MG TABLET RAP DR [Prevacid] ![Compare how all Medicare Part D PDP plans in WV cover LANSOPRAZOLE ODT 15 MG TABLET RAP DR [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LANSOPRAZOLE ODT 30 MG TABLET RAP DR [Prevacid] ![Compare how all Medicare Part D PDP plans in WV cover LANSOPRAZOLE ODT 30 MG TABLET RAP DR [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in WV cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Larissia-28 tablet ![Compare how all Medicare Part D PDP plans in WV cover Larissia-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Lartruvo 19 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in WV cover Lartruvo 19 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LARTRUVO 500 MG/50 ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover LARTRUVO 500 MG/50 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LASIX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LASIX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LASIX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LASIX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LASIX 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LASIX 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LASTACAFT 2.5mg/mL 1 BOTTLE, PLASTIC per CARTON / 3 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WV cover LASTACAFT 2.5mg/mL 1 BOTTLE, PLASTIC per CARTON / 3 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in WV cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:240 /30Days |
LATUDA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LATUDA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
LATUDA 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LATUDA 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
LAYOLIS FE CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WV cover LAYOLIS FE CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEENA 28 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEENA 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEFLUNOMIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEFLUNOMIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEFLUNOMIDE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEFLUNOMIDE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WV cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WV cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
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 WV cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WV cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WV cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WV cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LESCOL XL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LESCOL XL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /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 WV 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) |
2 |
Generic |
$5.00 | $10.00 | None |
LETAIRIS 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LETAIRIS 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LETAIRIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LETAIRIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEUCOVORIN CALCIUM 100MG VL ![Compare how all Medicare Part D PDP plans in WV cover LEUCOVORIN CALCIUM 100MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Leucovorin Calcium 15mg/1 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Leucovorin Calcium 15mg/1 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEUCOVORIN CALCIUM 25MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEUCOVORIN CALCIUM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEUCOVORIN CALCIUM 350MG VL ![Compare how all Medicare Part D PDP plans in WV cover LEUCOVORIN CALCIUM 350MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEUCOVORIN CALCIUM 5 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LEUCOVORIN CALCIUM 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in WV cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
LEVALBUTEROL 0.31 MG/3 ML SOL ![Compare how all Medicare Part D PDP plans in WV cover LEVALBUTEROL 0.31 MG/3 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
LEVALBUTEROL 0.63 MG/3 ML SOL ![Compare how all Medicare Part D PDP plans in WV cover LEVALBUTEROL 0.63 MG/3 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
LEVALBUTEROL 1.25 MG/0.5 ML ![Compare how all Medicare Part D PDP plans in WV cover LEVALBUTEROL 1.25 MG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Levalbuterol conc 1.25 mg/0.5 ![Compare how all Medicare Part D PDP plans in WV cover Levalbuterol conc 1.25 mg/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex] ![Compare how all Medicare Part D PDP plans in WV cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVAQUIN 500mg/1 50 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover LEVAQUIN 500mg/1 50 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVAQUIN 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVAQUIN 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVEMIR 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover LEVEMIR 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVEMIR FLEXTOUCH 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in WV cover LEVEMIR FLEXTOUCH 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVETIRACETAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVETIRACETAM 100 MG/ML SOLN ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 100 MG/ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Levetiracetam 100 ML 10 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WV cover Levetiracetam 100 ML 10 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Levetiracetam 100 ML 15 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WV cover Levetiracetam 100 ML 15 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Levetiracetam 100 ML 5 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WV cover Levetiracetam 100 ML 5 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVETIRACETAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVETIRACETAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM 500 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 500 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVETIRACETAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVETIRACETAM ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVETIRACETAM ER 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVETIRACETAM ER 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVO-T 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVO-T 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVO-T 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVOCARNITINE 1 G/10 ML SOLN ![Compare how all Medicare Part D PDP plans in WV cover LEVOCARNITINE 1 G/10 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOCETIRIZINE 2.5 MG/5 ML SOL ![Compare how all Medicare Part D PDP plans in WV cover LEVOCETIRIZINE 2.5 MG/5 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:300 /30Days |
LEVOCETIRIZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOCETIRIZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Levofloxacin 500 MG per 20 ML Injection [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover Levofloxacin 500 MG per 20 ML Injection [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOFLOXACIN 500 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 500 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 WV 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 |
$100.00 | $300.00 | None |
LEVOFLOXACIN 750 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 750 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WV cover LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev] ![Compare how all Medicare Part D PDP plans in WV cover LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LEVOLEUCOVORIN 50 MG VIAL [Fusilev] ![Compare how all Medicare Part D PDP plans in WV cover LEVOLEUCOVORIN 50 MG VIAL [Fusilev].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONO-E ESTRAD 0.10-0.02-0.01 ![Compare how all Medicare Part D PDP plans in WV cover LEVONO-E ESTRAD 0.10-0.02-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVONOR-ETH ESTRAD 0.09-0.02 MG ![Compare how all Medicare Part D PDP plans in WV cover LEVONOR-ETH ESTRAD 0.09-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONOR-ETH ESTRAD 0.1-0.02 MG ![Compare how all Medicare Part D PDP plans in WV cover LEVONOR-ETH ESTRAD 0.1-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in WV cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in WV cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Levonor-eth Estrad 0.15-0.03-0.01 ![Compare how all Medicare Part D PDP plans in WV cover Levonor-eth Estrad 0.15-0.03-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in WV cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVONORG 0.15MG-EE 20-25-30MCG ![Compare how all Medicare Part D PDP plans in WV cover LEVONORG 0.15MG-EE 20-25-30MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in WV cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 100 MCG VIAL ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 100 MCG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LEXAPRO 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEXAPRO 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:45 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEXAPRO 20MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEXAPRO 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
LEXAPRO 5MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LEXAPRO 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:45 /30Days |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LEXIVA 700MG TABLETS ![Compare how all Medicare Part D PDP plans in WV cover LEXIVA 700MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LIALDA 1.2G TABLET DELAYED RELEASE ![Compare how all Medicare Part D PDP plans in WV cover LIALDA 1.2G TABLET DELAYED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LIDOCAINE 2% VISCOUS SOLN ![Compare how all Medicare Part D PDP plans in WV cover LIDOCAINE 2% VISCOUS SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LIDOCAINE 5% OINTMENT ![Compare how all Medicare Part D PDP plans in WV cover LIDOCAINE 5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:36 /30Days |
Lidocaine 5% patch ![Compare how all Medicare Part D PDP plans in WV cover Lidocaine 5% patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:90 /30Days |
LIDOCAINE HCL IV 4% SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover LIDOCAINE HCL IV 4% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 WV 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 WV 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIDOCAINE-PRILOCAINE CREAM ![Compare how all Medicare Part D PDP plans in WV cover LIDOCAINE-PRILOCAINE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
LIDODERM 5% PATCH ![Compare how all Medicare Part D PDP plans in WV cover LIDODERM 5% PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:90 /30Days |
LINDANE SHAMPOO 1MG 2 FLO BOT ![Compare how all Medicare Part D PDP plans in WV cover LINDANE SHAMPOO 1MG 2 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Linezolid 20 MG/ML Oral Suspension [Zyvox] ![Compare how all Medicare Part D PDP plans in WV cover Linezolid 20 MG/ML Oral Suspension [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:1800 /28Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in WV cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:56 /28Days |
LINEZOLID 600 MG/300 ML IV SOL [Zyvox] ![Compare how all Medicare Part D PDP plans in WV cover LINEZOLID 600 MG/300 ML IV SOL [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
LIORESAL IT 10 MG/20 ML KIT AMPUL ![Compare how all Medicare Part D PDP plans in WV cover LIORESAL IT 10 MG/20 ML KIT AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
LIORESAL IT 10 MG/5 ML KIT AMPUL ![Compare how all Medicare Part D PDP plans in WV cover LIORESAL IT 10 MG/5 ML KIT AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIOTHYRONINE SOD 25 MCG TAB ![Compare how all Medicare Part D PDP plans in WV cover LIOTHYRONINE SOD 25 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LIOTHYRONINE SOD 5 MCG TAB ![Compare how all Medicare Part D PDP plans in WV cover LIOTHYRONINE SOD 5 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
liothyronine sodium 10ug/mL 1 VIAL per CARTON / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WV 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) |
5 |
Specialty Tier |
33% | N/A | None |
LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WV cover LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LIPITOR 10MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIPITOR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIPITOR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIPITOR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIPITOR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIPITOR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIPITOR 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIPITOR 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIPOFEN 150MG CAPSULES ![Compare how all Medicare Part D PDP plans in WV cover LIPOFEN 150MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL-HCTZ 10-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL-HCTZ 20-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LISINOPRIL-HCTZ 20-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LITHIUM CARBONATE 150 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover LITHIUM CARBONATE 150 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
Lithium Carbonate 300 mg tab ![Compare how all Medicare Part D PDP plans in WV cover Lithium Carbonate 300 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LITHIUM CARBONATE 300MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover LITHIUM CARBONATE 300MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
Lithium Carbonate 450mg/1 ![Compare how all Medicare Part D PDP plans in WV cover Lithium Carbonate 450mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHIUM CARBONATE 600 MG CAP ![Compare how all Medicare Part D PDP plans in WV cover LITHIUM CARBONATE 600 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LITHIUM CARBONATE ER 300 MG TB ![Compare how all Medicare Part D PDP plans in WV cover LITHIUM CARBONATE ER 300 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WV cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LITHOBID ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LITHOBID ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LIVALO 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIVALO 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIVALO 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIVALO 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LIVALO 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LIVALO 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LOCOID 0.1% LIPOCREAM ![Compare how all Medicare Part D PDP plans in WV cover LOCOID 0.1% LIPOCREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOCOID 0.1% LOTION ![Compare how all Medicare Part D PDP plans in WV cover LOCOID 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOCOID 0.1% SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover LOCOID 0.1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LODOSYN TAB 25MG ![Compare how all Medicare Part D PDP plans in WV cover LODOSYN TAB 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lomotil 0.025; 2.5mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WV cover Lomotil 0.025; 2.5mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LOPERAMIDE HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOPERAMIDE HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOPID 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOPID 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in WV cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOPRESSOR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOPRESSOR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOPROX 1% SHAMPOO ![Compare how all Medicare Part D PDP plans in WV cover LOPROX 1% SHAMPOO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOPROX CREAM 90 GM ![Compare how all Medicare Part D PDP plans in WV cover LOPROX CREAM 90 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | Q:120 /30Days |
LORAZEPAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LORAZEPAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LORAZEPAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LORAZEPAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | Q:150 /30Days |
LORAZEPAM 2 MG/ML ORAL CONCENT ![Compare how all Medicare Part D PDP plans in WV cover LORAZEPAM 2 MG/ML ORAL CONCENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | Q:150 /30Days |
LORCET HD 10-325 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LORCET HD 10-325 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
Lorcet plus 7.5-325 mg tablet ![Compare how all Medicare Part D PDP plans in WV cover Lorcet plus 7.5-325 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in WV cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LOSARTAN POTASSIUM 100 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN POTASSIUM 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
LOSARTAN POTASSIUM 25 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN POTASSIUM 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
LOSARTAN POTASSIUM 50 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN POTASSIUM 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 100-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN-HCTZ 100-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
LOSARTAN-HCTZ 100-25 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN-HCTZ 100-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
LOSARTAN-HCTZ 50-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WV cover LOSARTAN-HCTZ 50-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOTEMAX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WV cover LOTEMAX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOTEMAX 0.5% OPHTHALMIC GEL ![Compare how all Medicare Part D PDP plans in WV cover LOTEMAX 0.5% OPHTHALMIC GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WV cover Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOTENSIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOTENSIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOTENSIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOTENSIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOTREL 10/20MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOTREL 10/20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LOTREL 10/40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOTREL 10/40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LOTREL 5/10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOTREL 5/10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LOTREL 5/20MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOTREL 5/20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LOTRISONE CREAM ![Compare how all Medicare Part D PDP plans in WV cover LOTRISONE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOTRONEX 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOTRONEX 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOTRONEX 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOTRONEX 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:60 /30Days |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LOVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $0.00 | None |
LOVAZA 1 GM CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOVAZA 1 GM CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
LOVENOX 100MG PREFILLED SYR ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 100MG PREFILLED SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LOVENOX 120 MG/0.8 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 120 MG/0.8 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LOVENOX 150MG PREFILLED SYR ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 150MG PREFILLED SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LOVENOX 300MG VIAL ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 300MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
LOVENOX 30MG PREFILLED SYRN ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 30MG PREFILLED SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOVENOX 40MG PREFILLED SYRN ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 40MG PREFILLED SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOVENOX 60MG PREFILLED SYRN ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 60MG PREFILLED SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOVENOX 80 MG/0.8 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WV cover LOVENOX 80 MG/0.8 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
LOW-OGESTREL-28 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LOW-OGESTREL-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
LOXAPINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LOXAPINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOXAPINE 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WV cover LOXAPINE 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOXAPINE CAPSULES 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover LOXAPINE CAPSULES 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LOXAPINE CAPSULES 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in WV cover LOXAPINE CAPSULES 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in WV cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Lumizyme 5mg/mL ![Compare how all Medicare Part D PDP plans in WV cover Lumizyme 5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUNESTA 2MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LUNESTA 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
LUNESTA 3MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LUNESTA 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUNESTA TABLETS 1MG 30 BOT ![Compare how all Medicare Part D PDP plans in WV cover LUNESTA TABLETS 1MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT 45 MG 6MO KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT 45 MG 6MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT-PED 11.25 MG KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT-PED 11.25 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT-PED 15 MG KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT-PED 15 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUPRON DEPOT-PED 30 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in WV cover LUPRON DEPOT-PED 30 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in WV cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LYNPARZA 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYNPARZA 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:946 /30Days |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:90 /30Days |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WV cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
LYSODREN 500MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LYSODREN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
LYSTEDA 650 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LYSTEDA 650 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WV cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |