2019 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Benefit Details
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The Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0) Formulary Drugs Starting with the Letter D in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $21.90 Deductible: $415 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 |
49% | 49% | Q:90 /30Days |
D-AMPHETAMINE ER 15 MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | Q:120 /30Days |
D-AMPHETAMINE ER 5 MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
D5%-1/2NS-KCL 10 MEQ/L IV SOL IV SOLN  |
4 |
Non-Preferred Drug |
49% | 49% | P |
D5%-1/2NS-KCL 40 MEQ/L IV SOL IV SOLN  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in AL cover DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days |
DALIRESP 250 MCG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /365Days |
DALIRESP 500 MCG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:30 /30Days |
DANAZOL 100 MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DANAZOL 50MG CAPSULE  |
3 |
Preferred Brand |
20% | 20% | 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 |
49% | 49% | None |
DANTROLENE SODIUM 100MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DANTROLENE SODIUM 25MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DANTROLENE SODIUM 50MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DAPSONE 25 MG TABLET  |
3 |
Preferred Brand |
20% | 20% | None |
DAPSONE TABLETS 100MG 30 BLPK  |
3 |
Preferred Brand |
20% | 20% | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in AL cover DAPTOMYCIN 350 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DAPTOMYCIN 500 MG VIAL [Cubicin] ![Compare how all Medicare Part D PDP plans in AL cover DAPTOMYCIN 500 MG VIAL [Cubicin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DARAPRIM 25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:90 /30Days |
DARIFENACIN ER 15 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in AL cover DARIFENACIN ER 15 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DARIFENACIN ER 7.5 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in AL cover DARIFENACIN ER 7.5 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DAURISMO 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
DAURISMO 25 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
DEBLITANE 0.35 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DELESTROGEN INJECTION 10MG/5ML VIALMD  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DELSTRIGO 100-300-300 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
Delyla-28 tablet  |
3 |
Preferred Brand |
20% | 20% | None |
DEMSER CAPSULES 250MG (100 CT)  |
5 |
Specialty Tier |
25% | N/A | None |
DEPEN 250MG TITRATAB  |
5 |
Specialty Tier |
25% | N/A | None |
DEPO-ESTRADIOL 5MG/ML VIAL  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEPO-PROVERA 400MG/ML VIAL  |
4 |
Non-Preferred Drug |
49% | 49% | Q:10 /28Days |
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 |
25% | N/A | Q:30 /30Days |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in AL cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESLORATADINE 5 MG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DESMOPRESSIN ACETATE 0.1 MG TB  |
2* |
Generic |
$3.00 | $6.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TB  |
2* |
Generic |
$3.00 | $6.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR  |
4 |
Non-Preferred Drug |
49% | 49% | Q:15 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOGESTR-ETH ESTRA 0.15-0.03MG  |
3 |
Preferred Brand |
20% | 20% | None |
DESOGESTR-ETH ESTRAD  |
2* |
Generic |
$3.00 | $6.00 | None |
Desonide 0.0005 MG/MG Topical Ointment  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESONIDE 0.05% LOTION  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Desoximetasone 0.0005 MG/MG Topical Ointment  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESOXIMETASONE 0.25% CREAM  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DESOXIMETASONE 0.25% OINTMENT  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Desvenlafaxine Succinate ER 100 mg [Pristiq] ![Compare how all Medicare Part D PDP plans in AL cover Desvenlafaxine Succinate ER 100 mg [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
Desvenlafaxine Succinate ER 25 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in AL cover Desvenlafaxine Succinate ER 25 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Desvenlafaxine Succinate ER 50 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in AL cover Desvenlafaxine Succinate ER 50 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 0.5MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXAMETHASONE 0.5MG/5ML ELX  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 0.75MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 1.5MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 1MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 2MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 4MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DEXAMETHASONE 6MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE HCL 10MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 5MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 10 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TAB  |
3 |
Preferred Brand |
20% | 20% | Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TAB  |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE 10 MG TAB  |
4 |
Non-Preferred Drug |
49% | 49% | Q:180 /30Days |
DEXTROAMPHETAMINE 5 MG TAB  |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT)  |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX  |
4 |
Non-Preferred Drug |
49% | 49% | P |
Dextrose 10%-water iv solution  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DEXTROSE 2.5%-1/2NS IV SOLUTION  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DEXTROSE 5%-0.45% NACL IV SOLN  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXTROSE 5%-0.9% NACL IV SOLN  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXTROSE 5%-1/4NS IV SOLUTION  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXTROSE 5%-WATER IV SOLN  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION  |
4 |
Non-Preferred Drug |
49% | 49% | P |
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  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DIASTAT 2.5 MG PEDI SYSTEM  |
4 |
Non-Preferred Drug |
49% | 49% | Q:5 /30Days |
DIASTAT ACUDIAL 12.5-15-20 MG  |
4 |
Non-Preferred Drug |
49% | 49% | Q:40 /30Days |
DIASTAT ACUDIAL 5-7.5-10 MG KT  |
4 |
Non-Preferred Drug |
49% | 49% | Q:20 /30Days |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in AL cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in AL cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:120 /30Days |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in AL cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:120 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION  |
2* |
Generic |
$3.00 | $6.00 | Q:1200 /30Days |
DICLOFENAC 0.1% EYE DROPS [Voltaren] ![Compare how all Medicare Part D PDP plans in AL cover DICLOFENAC 0.1% EYE DROPS [Voltaren].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | None |
DICLOFENAC POT 50 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | 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 |
$3.00 | $6.00 | None |
DICLOFENAC SOD EC 50 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | None |
DICLOFENAC SOD EC 75 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | None |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in AL cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | None |
Diclofenac sodium 1.5% soln  |
4 |
Non-Preferred Drug |
49% | 49% | Q:1050 /30Days |
Diclofenac Sodium 1% gel  |
3 |
Preferred Brand |
20% | 20% | Q:1000 /30Days |
DICLOXACILLIN 250MG CAPSULE  |
2* |
Generic |
$3.00 | $6.00 | None |
DICLOXACILLIN SODIUM 500MG CAP  |
2* |
Generic |
$3.00 | $6.00 | None |
DICYCLOMINE 10 MG CAPSULE  |
2* |
Generic |
$3.00 | $6.00 | None |
DICYCLOMINE 20 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP  |
4 |
Non-Preferred Drug |
49% | 49% | 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 AL cover DIDANOSINE DR 200 MG CAPSULE DR [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DIDANOSINE DR 250 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in AL cover DIDANOSINE DR 250 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DIDANOSINE DR 400 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in AL cover DIDANOSINE DR 400 MG CAPSULE [Videx EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |
DIFLUNISAL 500 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DIGITEK 125 MCG TABLET  |
3 |
Preferred Brand |
20% | 20% | Q:30 /30Days |
DIGITEK 250 MCG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DIGOX 125 MCG TABLET  |
3 |
Preferred Brand |
20% | 20% | Q:30 /30Days |
DIGOX 250 MCG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in AL cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | Q:30 /30Days |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in AL cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | P |
DIHYDROERGOTAMINE 4 MG/ML SPRAY  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:8 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILANTIN CAPSULES 30 MG ER  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DILT XR 120 MG CAPSULE  |
3 |
Preferred Brand |
20% | 20% | None |
DILT XR 180 MG CAPSULE  |
3 |
Preferred Brand |
20% | 20% | None |
DILT XR 240 MG CAPSULE  |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 24HR ER 420 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 24HR ER 420 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
20% | 20% | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in AL cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | 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 AL 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) |
4 |
Non-Preferred Drug |
49% | 49% | 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 AL 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) |
4 |
Non-Preferred Drug |
49% | 49% | None |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DIPHENOXYLATE/ATROPINE LIQ  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Diphtheria toxoid vaccine, inact 4 UNT/ML / tetanus toxoid vaccine, inact 4 UNT/ML Inj Sus  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIPYRIDAMOLE 25 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | P |
DIPYRIDAMOLE 50 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | P |
DIPYRIDAMOLE 75 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | P |
DISULFIRAM 250 MG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DISULFIRAM 500 MG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DIVALPROEX DR 125 MG CAP SPRNK  |
3 |
Preferred Brand |
20% | 20% | None |
DIVALPROEX SOD DR 125 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | None |
DIVALPROEX SOD DR 250 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | None |
DIVALPROEX SOD DR 500 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | None |
DIVALPROEX SOD ER 500 MG TAB  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT  |
4 |
Non-Preferred Drug |
49% | 49% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in AL cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in AL cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in AL cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:60 /30Days |
DONEPEZIL HCL 10 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DONEPEZIL HCL 5 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR  |
2* |
Generic |
$3.00 | $6.00 | Q:10 /30Days |
Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL  |
2* |
Generic |
$3.00 | $6.00 | Q:10 /30Days |
DOVATO 50-300 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
DOXAZOSIN MESYLATE 1 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 2 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
DOXAZOSIN MESYLATE 4 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
DOXAZOSIN MESYLATE 8 MG TAB  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DOXEPIN 10 MG/ML ORAL CONC  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DOXEPIN 10MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DOXEPIN 50 MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DOXEPIN 75MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DOXEPIN HCL 25MG CAPSULE (100 CT)  |
4 |
Non-Preferred Drug |
49% | 49% | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE  |
4 |
Non-Preferred Drug |
49% | 49% | P |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT  |
4 |
Non-Preferred Drug |
49% | 49% | P |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in AL cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | 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 AL cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:240 /30Days |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in AL cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:120 /30Days |
DOXY 100 VIAL  |
4 |
Non-Preferred Drug |
49% | 49% | None |
doxycycline 25 mg/5 ml susp  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DOXYCYCLINE HYCLATE 100 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DOXYCYCLINE HYCLATE 100 MG TAB  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT)  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DOXYCYCLINE HYCLATE 50 MG CAP  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DOXYCYCLINE MONO 100 MG CAP  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DOXYCYCLINE MONO 100 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DOXYCYCLINE MONO 150 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 50 MG CAP  |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
DOXYCYCLINE MONO 50 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DOXYCYCLINE MONO 75 MG TABLET  |
2* |
Generic |
$3.00 | $6.00 | None |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in AL cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in AL cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in AL cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days |
DROXIA 200MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DROXIA 300MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DROXIA 400MG CAPSULE  |
4 |
Non-Preferred Drug |
49% | 49% | None |
DUAVEE 0.45-20 MG TABLET  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:30 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in AL cover DULOXETINE HCL DR 20 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DULOXETINE HCL DR 30 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in AL cover DULOXETINE HCL DR 30 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:90 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in AL cover DULOXETINE HCL DR 60 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$3.00 | $6.00 | Q:60 /30Days |
duramorph 0.5 mg/ml ampule  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:180 /30Days |
duramorph 1 mg/ml ampule  |
4 |
Non-Preferred Drug |
49% | 49% | P Q:180 /30Days |
DUREZOL 0.05% EYE DROPS  |
3 |
Preferred Brand |
20% | 20% | None |
DUTASTERIDE 0.5 MG CAPSULE  |
2* |
Generic |
$3.00 | $6.00 | Q:30 /30Days |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 [Jalyn] ![Compare how all Medicare Part D PDP plans in AL cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 [Jalyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
49% | 49% | Q:30 /30Days |