2018 Medicare Part D Plan Formulary Information |
Aetna Medicare Premier Plan (PPO) (H5521-151-0)
Benefit Details
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The Aetna Medicare Premier Plan (PPO) (H5521-151-0) Formulary Drugs Starting with the Letter D in Morgan County, IN: CMS MA Region 13 which includes: IN Plan Monthly Premium: $52.00 Deductible: $95 |
Drugs Starting with Letter D
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
D-AMPHETAMINE ER 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover D-AMPHETAMINE ER 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
D-AMPHETAMINE ER 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover D-AMPHETAMINE ER 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
D-AMPHETAMINE ER 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover D-AMPHETAMINE ER 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
DACARBAZINE 200MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover DACARBAZINE 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DACTINOMYCIN 0.5 MG VIAL [Cosmegen] ![Compare how all Medicare Part D PDP plans in IN cover DACTINOMYCIN 0.5 MG VIAL [Cosmegen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DALIRESP 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DALIRESP 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DALIRESP 500 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DALIRESP 500 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DANAZOL 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DANAZOL 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DANAZOL CAPSULES USP 200MG (100 CT).](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 |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DAPSONE 5% GEL ![Compare how all Medicare Part D PDP plans in IN cover DAPSONE 5% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in IN cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in IN cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DAPTOMYCIN 500 MG VIAL [Cubicin] ![Compare how all Medicare Part D PDP plans in IN cover DAPTOMYCIN 500 MG VIAL [Cubicin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DARIFENACIN ER 15 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in IN cover DARIFENACIN ER 15 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DARIFENACIN ER 7.5 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in IN cover DARIFENACIN ER 7.5 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DARZALEX 100 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DARZALEX 100 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in IN cover daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DAYPRO 600MG CAPLET ![Compare how all Medicare Part D PDP plans in IN cover DAYPRO 600MG CAPLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DDAVP 0.01% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in IN cover DDAVP 0.01% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DDAVP 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DDAVP 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DDAVP 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DDAVP 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DDAVP 10 MCG/0.1 ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover DDAVP 10 MCG/0.1 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DDAVP 4 MCG/ML AMPUL ![Compare how all Medicare Part D PDP plans in IN cover DDAVP 4 MCG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEBLITANE 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Decitabine 50 mg vial [Dacogen] ![Compare how all Medicare Part D PDP plans in IN cover Decitabine 50 mg vial [Dacogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DELESTROGEN 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DELESTROGEN 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DELESTROGEN INJECTION 10MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover DELESTROGEN INJECTION 10MG/5ML VIALMD.](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 |
DELESTROGEN INJECTION 20MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover DELESTROGEN INJECTION 20MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Delyla-28 tablet ![Compare how all Medicare Part D PDP plans in IN cover Delyla-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DELZICOL DR 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DELZICOL DR 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEMADEX 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEMADEX 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEMADEX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEMADEX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEMEROL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEMEROL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
DEMEROL 25 MG/ML CARPUJECT ![Compare how all Medicare Part D PDP plans in IN cover DEMEROL 25 MG/ML CARPUJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DEMEROL 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEMEROL 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DENAVIR 1% CREAM ![Compare how all Medicare Part D PDP plans in IN cover DENAVIR 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKENE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DEPAKENE 250MG CAPSULE.](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 |
DEPAKOTE 125MG SPRINKLE CAP ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE 125MG SPRINKLE CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKOTE 125MG TABLET EC ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE 125MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKOTE DR 250 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE DR 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKOTE DR 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE DR 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKOTE ER 250MG TABLET SA ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE ER 250MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPAKOTE ER 500MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEPAKOTE ER 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in IN cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPO-MEDROL 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-MEDROL 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPO-MEDROL 40 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-MEDROL 40 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPO-MEDROL 80MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-MEDROL 80MG/ML VIAL.](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 |
DEPO-PROVERA 150 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-PROVERA 150 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in IN cover Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEPO-TESTOSTERONE 100 MG/ML VL ![Compare how all Medicare Part D PDP plans in IN cover DEPO-TESTOSTERONE 100 MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DESIPRAMINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESIPRAMINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESIPRAMINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESIPRAMINE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT.](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 |
DESLORATADINE 2.5 MG ODDT ![Compare how all Medicare Part D PDP plans in IN cover DESLORATADINE 2.5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DESLORATADINE 5 MG ODDT ![Compare how all Medicare Part D PDP plans in IN cover DESLORATADINE 5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Desmopressin ac 4 mcg/ml vial ![Compare how all Medicare Part D PDP plans in IN cover Desmopressin ac 4 mcg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESMOPRESSIN ACETATE 0.1 MG TB ![Compare how all Medicare Part D PDP plans in IN cover DESMOPRESSIN ACETATE 0.1 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TB ![Compare how all Medicare Part D PDP plans in IN cover DESMOPRESSIN ACETATE 0.2 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in IN cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DESOGESTR-ETH ESTRA 0.15-0.03MG ![Compare how all Medicare Part D PDP plans in IN cover DESOGESTR-ETH ESTRA 0.15-0.03MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DESOGESTR-ETH ESTRAD ![Compare how all Medicare Part D PDP plans in IN cover DESOGESTR-ETH ESTRAD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DESONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in IN cover DESONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Desonide 0.0005 MG/MG Topical Ointment ![Compare how all Medicare Part D PDP plans in IN cover Desonide 0.0005 MG/MG Topical Ointment.](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 |
DESONIDE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IN cover DESONIDE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESONIDE 0.05% LOTION ![Compare how all Medicare Part D PDP plans in IN cover DESONIDE 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DesOwen 0.5mg/g 118 g in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover DesOwen 0.5mg/g 118 g in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DesOwen 0.5mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IN cover DesOwen 0.5mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Desoximetasone 0.0005 MG/MG Topical Ointment ![Compare how all Medicare Part D PDP plans in IN cover Desoximetasone 0.0005 MG/MG Topical Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESOXIMETASONE 0.25% CREAM ![Compare how all Medicare Part D PDP plans in IN cover DESOXIMETASONE 0.25% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESOXIMETASONE 0.25% OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover DESOXIMETASONE 0.25% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IN cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IN cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DESVENLAFAXINE ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DESVENLAFAXINE ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DESVENLAFAXINE ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DESVENLAFAXINE ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Desvenlafaxine Succinate ER 25 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in IN cover Desvenlafaxine Succinate ER 25 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
DETROL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DETROL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
DETROL 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DETROL 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
DETROL LA 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DETROL LA 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DETROL LA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DETROL LA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 1.5 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 |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
Dexamethasone 10 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in IN cover Dexamethasone 10 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD ![Compare how all Medicare Part D PDP plans in IN cover DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXEDRINE 10mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover DEXEDRINE 10mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
DEXEDRINE 15mg 90 BOTTLE per CARTON / 90 CAPSULE, ER in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover DEXEDRINE 15mg 90 BOTTLE per CARTON / 90 CAPSULE, ER in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
DEXEDRINE 5mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in IN cover DEXEDRINE 5mg 90 BOTTLE, PLASTIC per CARTON / 90 CAPSULE, ER in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:120 /30Days |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in IN cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](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 |
DEXILANT DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DEXILANT DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXMETHYLPHENIDATE ER 15 MG CP ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE ER 15 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
Dexmethylphenidate er 20 mg cp ![Compare how all Medicare Part D PDP plans in IN cover Dexmethylphenidate er 20 mg cp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
Dexmethylphenidate er 25 mg cp ![Compare how all Medicare Part D PDP plans in IN cover Dexmethylphenidate er 25 mg cp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXMETHYLPHENIDATE ER 30 MG CP ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE ER 30 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
Dexmethylphenidate er 35 mg cp ![Compare how all Medicare Part D PDP plans in IN cover Dexmethylphenidate er 35 mg cp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXMETHYLPHENIDATE ER 40 MG CP ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE ER 40 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXMETHYLPHENIDATE ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
Dexrazoxane 500 MG Vial ![Compare how all Medicare Part D PDP plans in IN cover Dexrazoxane 500 MG Vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROAMP-AMPHET ER 10 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 10 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 15 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 20 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 30 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHET ER 5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHETAMIN 20 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMP-AMPHETAMIN 30 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMPHETAMINE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE 5 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMPHETAMINE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:180 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:60 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Dextrose 10%-water iv solution ![Compare how all Medicare Part D PDP plans in IN cover Dextrose 10%-water iv solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROSE 5%-0.45% NACL IV SOLN ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 5%-0.45% NACL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROSE 5%-0.9% NACL IV SOLN ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 5%-0.9% NACL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Dextrose 5%-lr iv solution ![Compare how all Medicare Part D PDP plans in IN cover Dextrose 5%-lr iv solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROSE 5%-WATER IV SOLN ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE 5%-WATER IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](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 |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in IN cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIASTAT 2.5 MG PEDI SYSTEM ![Compare how all Medicare Part D PDP plans in IN cover DIASTAT 2.5 MG PEDI SYSTEM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIASTAT ACUDIAL 12.5-15-20 MG ![Compare how all Medicare Part D PDP plans in IN cover DIASTAT ACUDIAL 12.5-15-20 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIASTAT ACUDIAL 5-7.5-10 MG KT ![Compare how all Medicare Part D PDP plans in IN cover DIASTAT ACUDIAL 5-7.5-10 MG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in IN cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in IN cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
Diazepam 5 MG Oral Tablet [Valium] ![Compare how all Medicare Part D PDP plans in IN cover Diazepam 5 MG Oral Tablet [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in IN cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in IN cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1200 /30Days |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in IN cover DIAZEPAM 5 MG/ML ORAL CONC.](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 |
DICLOFENAC 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOFENAC POT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC POT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOFENAC SOD EC 25 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC SOD EC 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOFENAC SOD EC 50 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC SOD EC 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOFENAC SOD EC 75 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC SOD EC 75 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOFENAC SOD ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DICLOFENAC SOD ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
Diclofenac sodium 1.5% soln ![Compare how all Medicare Part D PDP plans in IN cover Diclofenac sodium 1.5% soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:450 /30Days |
Diclofenac Sodium 1% gel ![Compare how all Medicare Part D PDP plans in IN cover Diclofenac Sodium 1% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:1000 /30Days |
Diclofenac Sodium 3% gel ![Compare how all Medicare Part D PDP plans in IN cover Diclofenac Sodium 3% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:100 /30Days |
diclofenac-misoprost 50-0.2 tablet ![Compare how all Medicare Part D PDP plans in IN cover diclofenac-misoprost 50-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
diclofenac-misoprost 75-0.2 tablet ![Compare how all Medicare Part D PDP plans in IN cover diclofenac-misoprost 75-0.2 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 |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DICYCLOMINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DICYCLOMINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DICYCLOMINE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in IN cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Dicyclomine hydrochloride 20 MG per 2 ML Injection ![Compare how all Medicare Part D PDP plans in IN cover Dicyclomine hydrochloride 20 MG per 2 ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIDANOSINE DR 200 MG CAPSULE DR [Videx EC] ![Compare how all Medicare Part D PDP plans in IN cover DIDANOSINE DR 200 MG CAPSULE DR [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIDANOSINE DR 250 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in IN cover DIDANOSINE DR 250 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIDANOSINE DR 400 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in IN cover DIDANOSINE DR 400 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in IN cover DIFLORASONE 0.05% CREAM.](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 |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in IN cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 100MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 150MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 200MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 200MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 200MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUCAN 50MG/5ML SUSPEN ![Compare how all Medicare Part D PDP plans in IN cover DIFLUCAN 50MG/5ML SUSPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIFLUNISAL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIFLUNISAL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIGITEK 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIGITEK 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGITEK 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIGITEK 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGOX 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIGOX 125 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 |
DIGOX 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIGOX 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin] ![Compare how all Medicare Part D PDP plans in IN cover DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in IN cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in IN cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIGOXIN 500 MCG/2 ML AMPULE [Lanoxin] ![Compare how all Medicare Part D PDP plans in IN cover DIGOXIN 500 MCG/2 ML AMPULE [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIHYDROERGOTAMINE 1 MG/ML AM ![Compare how all Medicare Part D PDP plans in IN cover DIHYDROERGOTAMINE 1 MG/ML AM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in IN cover DIHYDROERGOTAMINE 4 MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:8 /28Days |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in IN cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in IN cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in IN cover DILANTIN-125 SUS 125/5ML.](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 |
DILAUDID 2 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DILAUDID 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
DILAUDID 4 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DILAUDID 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
DILAUDID 5 MG/5 ML ORAL LIQUID ![Compare how all Medicare Part D PDP plans in IN cover DILAUDID 5 MG/5 ML ORAL LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:2400 /30Days |
DILAUDID 8 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DILAUDID 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](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 |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 24HR ER 360 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 360 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 24HR ER 420 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 24HR ER 420 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 25 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 25 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DILTIAZEM HCL 100MG VIAL ![Compare how all Medicare Part D PDP plans in IN cover DILTIAZEM HCL 100MG VIAL.](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 |
DIOVAN 160MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
DIOVAN 320MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIOVAN 40MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
DIOVAN 80MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
DIOVAN HCT 160/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN HCT 160/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIOVAN HCT 160/25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN HCT 160/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIOVAN HCT 320/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN HCT 320/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIOVAN HCT 320/25MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN HCT 320/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIOVAN HCT 80/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIOVAN HCT 80/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /30Days |
DIPENTUM 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DIPENTUM 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix] ![Compare how all Medicare Part D PDP plans in IN cover Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix].](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 |
Diph-Tetanus Tox-Acell Pert-Hepatitis B-Polio IPV Vac 0.5 ML Prefilled Syringe [Pediarix] ![Compare how all Medicare Part D PDP plans in IN cover Diph-Tetanus Tox-Acell Pert-Hepatitis B-Polio IPV Vac 0.5 ML Prefilled Syringe [Pediarix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
diphenhydramine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in IN cover diphenhydramine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in IN cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension ![Compare how all Medicare Part D PDP plans in IN cover Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Diphtheria toxoid vaccine, inact 4 UNT/ML / tetanus toxoid vaccine, inact 4 UNT/ML Inj Sus ![Compare how all Medicare Part D PDP plans in IN cover Diphtheria toxoid vaccine, inact 4 UNT/ML / tetanus toxoid vaccine, inact 4 UNT/ML Inj Sus.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIPYRIDAMOLE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIPYRIDAMOLE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DIPYRIDAMOLE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIPYRIDAMOLE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DIPYRIDAMOLE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DIPYRIDAMOLE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DISOPYRAMIDE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DISOPYRAMIDE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](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 |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DISULFIRAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DISULFIRAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DITROPAN XL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DITROPAN XL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
DITROPAN XL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DITROPAN XL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
DITROPAN XL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DITROPAN XL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in IN cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIVALPROEX DR 125 MG CAP SPRNK ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX DR 125 MG CAP SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIVALPROEX SOD DR 125 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX SOD DR 125 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIVALPROEX SOD DR 250 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX SOD DR 250 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIVALPROEX SOD DR 500 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX SOD DR 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DIVALPROEX SOD ER 500 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX SOD ER 500 MG TAB.](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 |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DIVIGEL 1 MG GEL PACKET ![Compare how all Medicare Part D PDP plans in IN cover DIVIGEL 1 MG GEL PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOCETAXEL 160 MG/16 ML VIAL ![Compare how all Medicare Part D PDP plans in IN cover DOCETAXEL 160 MG/16 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | None |
Docetaxel 80 mg/4 ml vial ![Compare how all Medicare Part D PDP plans in IN cover Docetaxel 80 mg/4 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in IN cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in IN cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in IN cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOLOPHINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DOLOPHINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover DOLOPHINE HYDROCHLORIDE 5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:60 /30Days |
DONEPEZIL HCL 23 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DONEPEZIL HCL 23 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | Q:30 /30Days |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in IN cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL ![Compare how all Medicare Part D PDP plans in IN cover Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
DOVONEX CREAM ![Compare how all Medicare Part D PDP plans in IN cover DOVONEX CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:120 /30Days |
DOXAZOSIN MESYLATE 1 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXAZOSIN MESYLATE 1 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXAZOSIN MESYLATE 2 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXAZOSIN MESYLATE 2 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXAZOSIN MESYLATE 4 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXAZOSIN MESYLATE 4 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXAZOSIN MESYLATE 8 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXAZOSIN MESYLATE 8 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXEPIN 10 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN 10 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
DOXEPIN 5% CREAM ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:45 /30Days |
DOXEPIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in IN cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
Doxepin Hydrochloride 50 MG/ML Topical Cream [Zonalon] ![Compare how all Medicare Part D PDP plans in IN cover Doxepin Hydrochloride 50 MG/ML Topical Cream [Zonalon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:45 /30Days |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in IN cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IN cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IN cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in IN cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](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 |
Doxercalciferol 4 mcg/2 ml amp [HECTOROL] ![Compare how all Medicare Part D PDP plans in IN cover Doxercalciferol 4 mcg/2 ml amp [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Doxorubicin Hydrochloride 2mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 25 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in IN cover Doxorubicin Hydrochloride 2mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 25 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Doxorubicin liposome 20mg/10ml ![Compare how all Medicare Part D PDP plans in IN cover Doxorubicin liposome 20mg/10ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in IN cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in IN cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
Doxycycline 75mg/1 ![Compare how all Medicare Part D PDP plans in IN cover Doxycycline 75mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOXYCYCLINE HYC DR 100 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYC DR 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOXYCYCLINE HYC DR 150 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYC DR 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Doxycycline hyc dr 200 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover Doxycycline hyc dr 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Doxycycline hyc dr 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover Doxycycline hyc dr 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DOXYCYCLINE HYC DR 75 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYC DR 75 MG TAB.](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 |
DOXYCYCLINE HYCLATE 100 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE HYCLATE 100 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE HYCLATE 150 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE HYCLATE 50 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE HYCLATE 75 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE HYCLATE 75 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DOXYCYCLINE MONO 100 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXYCYCLINE MONO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXYCYCLINE MONO 50 MG CAP ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 50 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 |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
Doxycycline Monohydrate 150 MG Oral Capsule ![Compare how all Medicare Part D PDP plans in IN cover Doxycycline Monohydrate 150 MG Oral Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DRONABINOL CAPS 10MG ![Compare how all Medicare Part D PDP plans in IN cover DRONABINOL CAPS 10MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
DRONABINOL CAPS 2.5MG ![Compare how all Medicare Part D PDP plans in IN cover DRONABINOL CAPS 2.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
DRONABINOL CAPS 5MG ![Compare how all Medicare Part D PDP plans in IN cover DRONABINOL CAPS 5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
DROSP-EE-LEVOMEF 3-0.02-0.451 [Beyaz, Safyral] ![Compare how all Medicare Part D PDP plans in IN cover DROSP-EE-LEVOMEF 3-0.02-0.451 [Beyaz, Safyral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DROSPIRENONE-EE 3-0.02 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DROSPIRENONE-EE 3-0.02 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DROSPIRENONE-EE 3-0.03 MG TAB ![Compare how all Medicare Part D PDP plans in IN cover DROSPIRENONE-EE 3-0.03 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DROXIA 400MG CAPSULE.](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 |
DUAC 50; 10mg/g; mg/g 1 TUBE in 1 CARTON / 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in IN cover DUAC 50; 10mg/g; mg/g 1 TUBE in 1 CARTON / 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DUETACT 30MG-2MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DUETACT 30MG-2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DUETACT 30MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in IN cover DUETACT 30MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DUEXIS 26.6; 800mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in IN cover DUEXIS 26.6; 800mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DULOXETINE HCL DR 20 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in IN cover DULOXETINE HCL DR 20 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
DULOXETINE HCL DR 30 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in IN cover DULOXETINE HCL DR 30 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:90 /30Days |
DULOXETINE HCL DR 40 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in IN cover DULOXETINE HCL DR 40 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
DULOXETINE HCL DR 60 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in IN cover DULOXETINE HCL DR 60 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days |
DUOPA 4.63 MG-20 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in IN cover DUOPA 4.63 MG-20 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P |
duramorph 0.5 mg/ml ampule ![Compare how all Medicare Part D PDP plans in IN cover duramorph 0.5 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
duramorph 1 mg/ml ampule ![Compare how all Medicare Part D PDP plans in IN cover duramorph 1 mg/ml ampule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in IN cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
DUTASTERIDE 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DUTASTERIDE 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 [Jalyn] ![Compare how all Medicare Part D PDP plans in IN cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 [Jalyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
DYAZIDE 37.5-25 CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DYAZIDE 37.5-25 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DYRENIUM 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DYRENIUM 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
DYRENIUM 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in IN cover DYRENIUM 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |