2018 Medicare Part D Plan Formulary Information |
AARP MedicareRx Preferred (PDP) (S5820-020-0)
Benefit Details
 |
The AARP MedicareRx Preferred (PDP) (S5820-020-0) Formulary Drugs Starting with the Letter D in CMS PDP Region 21 which includes: LA Plan Monthly Premium: $90.00 Deductible: $0 Qualifies for LIS: No |
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  |
4 |
Non-Preferred Drug |
40% | 40% | Q:180 /30Days |
D-AMPHETAMINE ER 15 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | Q:120 /30Days |
D-AMPHETAMINE ER 5 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | Q:90 /30Days |
DACARBAZINE 200MG VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DACTINOMYCIN 0.5 MG VIAL [Cosmegen] ![Compare how all Medicare Part D PDP plans in LA cover DACTINOMYCIN 0.5 MG VIAL [Cosmegen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DALIRESP 250 MCG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | P Q:30 /30Days |
DALIRESP 500 MCG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | P Q:30 /30Days |
DALVANCE 500 MG VIAL  |
5 |
Specialty Tier |
33% | 33% | P |
DANAZOL 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DANAZOL 50MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANAZOL CAPSULES USP 200MG (100 CT)  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DANTROLENE SODIUM 100MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DANTROLENE SODIUM 25MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DANTROLENE SODIUM 50MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DAPSONE 25 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DAPSONE TABLETS 100MG 30 BLPK  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DAPTOMYCIN 500 MG VIAL [Cubicin] ![Compare how all Medicare Part D PDP plans in LA cover DAPTOMYCIN 500 MG VIAL [Cubicin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
DARAPRIM 25 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DARZALEX 100 MG/5 ML VIAL  |
5 |
Specialty Tier |
33% | 33% | P |
daunorubicin hydrochloride 5mg/mL 10 VIAL per CARTON / 4 mL in 1 VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEBLITANE 0.35 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Decitabine 50 mg vial [Dacogen] ![Compare how all Medicare Part D PDP plans in LA cover Decitabine 50 mg vial [Dacogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Delyla-28 tablet  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEMECLOCYCLINE 150 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEMECLOCYCLINE 300 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEMSER CAPSULES 250MG (100 CT)  |
5 |
Specialty Tier |
33% | 33% | None |
DENAVIR 1% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | Q:5 /30Days |
DEPEN 250MG TITRATAB  |
5 |
Specialty Tier |
33% | 33% | None |
DEPO-ESTRADIOL 5MG/ML VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEPO-MEDROL 20MG/ML VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEPO-PROVERA 400MG/ML VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESCOVY 200-25 MG TABLET  |
5 |
Specialty Tier |
33% | 33% | Q:60 /30Days |
DESIPRAMINE 10 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESIPRAMINE 25MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESIPRAMINE 50MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESIPRAMINE 75 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESIPRAMINE HYDROCHLORIDE 150 MG TABLETS  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESIPRAMINE HYDROCHLORIDE TABLETS USP 100MG 100 BOT  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Desmopressin ac 4 mcg/ml vial  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DESMOPRESSIN ACETATE 0.1 MG TB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOGESTR-ETH ESTRA 0.15-0.03MG  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DESOGESTR-ETH ESTRAD  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Desonide 0.0005 MG/MG Topical Ointment  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DESOXIMETASONE 0.25% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Desvenlafaxine Succinate ER 100 mg [Pristiq] ![Compare how all Medicare Part D PDP plans in LA cover Desvenlafaxine Succinate ER 100 mg [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:120 /30Days |
Desvenlafaxine Succinate ER 25 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in LA cover Desvenlafaxine Succinate ER 25 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
Desvenlafaxine Succinate ER 50 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in LA cover Desvenlafaxine Succinate ER 50 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 0.5MG/5ML ELX  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Dexamethasone 10 MG/ML Injectable Solution  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXAMETHASONE 1MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DEXAMETHASONE SODIUM PHOSPHATE INJECTION 4MG 30ML VIALMD  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
DEXILANT DR 60 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE ER 10 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXMETHYLPHENIDATE ER 15 MG CP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dexmethylphenidate er 20 mg cp  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dexmethylphenidate er 25 mg cp  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXMETHYLPHENIDATE ER 30 MG CP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dexmethylphenidate er 35 mg cp  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXMETHYLPHENIDATE ER 40 MG CP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXMETHYLPHENIDATE ER 5 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXMETHYLPHENIDATE HCL 10MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 5MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Dexrazoxane 500 MG Vial  |
5 |
Specialty Tier |
33% | 33% | P |
DEXTROAMP-AMPHET ER 10 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAP  |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TAB  |
4 |
Non-Preferred Drug |
40% | 40% | Q:180 /30Days |
DEXTROAMPHETAMINE 5 MG TAB  |
4 |
Non-Preferred Drug |
40% | 40% | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT)  |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dextrose 10%-water iv solution  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE 5%-0.45% NACL IV SOLN  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE 5%-0.9% NACL IV SOLN  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE 5%-1/4NS IV SOLUTION  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dextrose 5%-lr iv solution  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE 5%-WATER IV SOLN  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIASTAT 2.5 MG PEDI SYSTEM  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIASTAT ACUDIAL 12.5-15-20 MG  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIASTAT ACUDIAL 5-7.5-10 MG KT  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in LA cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in LA cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in LA cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION  |
2 |
Generic |
$8.00 | $0.00 | None |
DIAZEPAM 5 MG/ML ORAL CONC  |
2 |
Generic |
$8.00 | $0.00 | Q:240 /30Days |
DICLOFENAC 0.1% EYE DROPS  |
2 |
Generic |
$8.00 | $0.00 | None |
DICLOFENAC POT 50 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC SOD EC 25 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DICLOFENAC SOD EC 50 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DICLOFENAC SOD ER 100 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
Diclofenac Sodium 1% gel  |
3 |
Preferred Brand |
$37.00 | $96.00 | P |
Diclofenac Sodium 3% gel  |
5 |
Specialty Tier |
33% | 33% | P |
DICLOXACILLIN 250MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAP  |
2 |
Generic |
$8.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE  |
2 |
Generic |
$8.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIDANOSINE DR 200 MG CAPSULE DR [Videx EC] ![Compare how all Medicare Part D PDP plans in LA cover DIDANOSINE DR 200 MG CAPSULE DR [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DIDANOSINE DR 250 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in LA cover DIDANOSINE DR 250 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
DIDANOSINE DR 400 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in LA cover DIDANOSINE DR 400 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | Q:60 /30Days |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE  |
5 |
Specialty Tier |
33% | 33% | None |
DIFLUNISAL 500 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DIGITEK 125 MCG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DIGITEK 250 MCG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DIGOX 125 MCG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DIGOX 250 MCG TABLET  |
2 |
Generic |
$8.00 | $0.00 | None |
DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin] ![Compare how all Medicare Part D PDP plans in LA cover DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in LA cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in LA cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
DIGOXIN 500 MCG/2 ML AMPULE [Lanoxin] ![Compare how all Medicare Part D PDP plans in LA cover DIGOXIN 500 MCG/2 ML AMPULE [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
DIHYDROERGOTAMINE 1 MG/ML AM  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DILANTIN 50MG INFATAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILANTIN CAPSULES 30 MG ER  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT)  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILT XR 120 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILT XR 180 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILT XR 240 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 360 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 360 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 24HR ER 420 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 24HR ER 420 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DILTIAZEM 25 MG/5 ML VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in LA cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | None |
DILTIAZEM HCL 100MG VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | 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 LA 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 |
$37.00 | $96.00 | None |
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 LA 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 |
$37.00 | $96.00 | None |
diphenhydramine 50 mg/ml vial  |
4 |
Non-Preferred Drug |
40% | 40% | P |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DIPHENOXYLATE/ATROPINE LIQ  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Diphtheria toxoid vaccine, inact 4 UNT/ML / tetanus toxoid vaccine, inact 4 UNT/ML Inj Sus  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DISULFIRAM 250 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DISULFIRAM 500 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIURIL 250MG/5ML SUSPENSION ORAL  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DIVALPROEX DR 125 MG CAP SPRNK  |
2 |
Generic |
$8.00 | $0.00 | None |
DIVALPROEX SOD DR 125 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DIVALPROEX SOD ER 500 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT  |
2 |
Generic |
$8.00 | $0.00 | None |
DOCETAXEL 160 MG/16 ML VIAL  |
5 |
Specialty Tier |
33% | 33% | None |
Docetaxel 80 mg/4 ml vial  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in LA cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in LA cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in LA cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
DONEPEZIL HCL 10 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
DONEPEZIL HCL 23 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
DONEPEZIL HCL 5 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET  |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
DORIPENEM 500 MG VIAL [Doribax] ![Compare how all Medicare Part D PDP plans in LA cover DORIPENEM 500 MG VIAL [Doribax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR  |
2 |
Generic |
$8.00 | $0.00 | None |
Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL  |
2 |
Generic |
$8.00 | $0.00 | None |
DOXAZOSIN MESYLATE 1 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DOXAZOSIN MESYLATE 2 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 4 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DOXAZOSIN MESYLATE 8 MG TAB  |
2 |
Generic |
$8.00 | $0.00 | None |
DOXEPIN 10 MG/ML ORAL CONC  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXEPIN 10MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXEPIN 5% CREAM  |
4 |
Non-Preferred Drug |
40% | 40% | P |
DOXEPIN 50 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXEPIN 75MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXEPIN HCL 25MG CAPSULE (100 CT)  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in LA cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in LA cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:120 /30Days |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in LA cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:120 /30Days |
Doxercalciferol 4 mcg/2 ml amp [HECTOROL] ![Compare how all Medicare Part D PDP plans in LA cover Doxercalciferol 4 mcg/2 ml amp [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
DOXIL 2mg/mL  |
5 |
Specialty Tier |
33% | 33% | None |
Doxorubicin Hydrochloride 2mg/mL 1 VIAL, SINGLE-DOSE per CARTON / 25 mL in 1 VIAL, SINGLE-DOSE  |
4 |
Non-Preferred Drug |
40% | 40% | P |
Doxorubicin liposome 20mg/10ml  |
5 |
Specialty Tier |
33% | 33% | None |
DOXY 100 VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | None |
doxycycline 25 mg/5 ml susp  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DOXYCYCLINE HYCLATE 100 MG CAP  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE HYCLATE 100 MG TAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE HYCLATE 150 MG TAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT)  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE HYCLATE 50 MG CAP  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE HYCLATE 75 MG TAB  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE MONO 100 MG CAP  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE MONO 100 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE MONO 50 MG CAP  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE MONO 50 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DOXYCYCLINE MONO 75 MG TABLET  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DRONABINOL CAPS 10MG  |
4 |
Non-Preferred Drug |
40% | 40% | P |
DRONABINOL CAPS 2.5MG  |
4 |
Non-Preferred Drug |
40% | 40% | P |
DRONABINOL CAPS 5MG  |
4 |
Non-Preferred Drug |
40% | 40% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROSPIRENONE-EE 3-0.02 MG TAB  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DROSPIRENONE-EE 3-0.03 MG TAB  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DROXIA 200MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DROXIA 300MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DROXIA 400MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DUAVEE 0.45-20 MG TABLET  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DULERA INHALATION AEROSOL  |
4 |
Non-Preferred Drug |
40% | 40% | Q:13 /30Days |
DULERA INHALATION AEROSOL  |
4 |
Non-Preferred Drug |
40% | 40% | Q:13 /30Days |
DULOXETINE HCL DR 20 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in LA cover DULOXETINE HCL DR 20 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
DULOXETINE HCL DR 30 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in LA cover DULOXETINE HCL DR 30 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
DULOXETINE HCL DR 60 MG CAP [Cymbalta] ![Compare how all Medicare Part D PDP plans in LA cover DULOXETINE HCL DR 60 MG CAP [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
duramorph 0.5 mg/ml ampule  |
4 |
Non-Preferred Drug |
40% | 40% | None |
duramorph 1 mg/ml ampule  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DUREZOL 0.05% EYE DROPS  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DUTASTERIDE 0.5 MG CAPSULE  |
3 |
Preferred Brand |
$37.00 | $96.00 | None |
DYMISTA NASAL SPRAY  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DYRENIUM 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
DYRENIUM 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
40% | 40% | None |
Dysport 3001/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | P |
DYSPORT 500 UNITS VIAL  |
4 |
Non-Preferred Drug |
40% | 40% | P |