2019 Medicare Part D Plan Formulary Information |
HumanaChoice H5525-038 (PPO) (H5525-038-0)
Benefit Details
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-038 (PPO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The HumanaChoice H5525-038 (PPO) (H5525-038-0) Formulary Drugs Starting with the Letter D in Adams County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $0.00 Deductible: $0 |
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 |
D5%-1/2NS-KCL 10 MEQ/L IV SOL IV SOLN ![Compare how all Medicare Part D PDP plans in PA cover D5%-1/2NS-KCL 10 MEQ/L IV SOL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
D5%-1/2NS-KCL 40 MEQ/L IV SOL IV SOLN ![Compare how all Medicare Part D PDP plans in PA cover D5%-1/2NS-KCL 40 MEQ/L IV SOL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in PA cover DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days |
DALIRESP 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DALIRESP 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:28 /365Days |
DALIRESP 500 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DALIRESP 500 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DANAZOL 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DAPSONE TABLETS 100MG 30 BLPK ![Compare how all Medicare Part D PDP plans in PA cover DAPSONE TABLETS 100MG 30 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DAPTACEL VACCINE 15;5;5;3; LF/.5ML ![Compare how all Medicare Part D PDP plans in PA cover DAPTACEL VACCINE 15;5;5;3; LF/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in PA cover DAPTOMYCIN 350 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DAPTOMYCIN 500 MG VIAL [Cubicin] ![Compare how all Medicare Part D PDP plans in PA cover DAPTOMYCIN 500 MG VIAL [Cubicin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DARAPRIM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DARAPRIM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DARIFENACIN ER 15 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in PA cover DARIFENACIN ER 15 MG TABLET [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:30 /30Days |
DARIFENACIN ER 7.5 MG TABLET [Enablex] ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | S Q:30 /30Days |
DAURISMO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAURISMO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
DAURISMO 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DAURISMO 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEBLITANE 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DELSTRIGO 100-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DELSTRIGO 100-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Delyla-28 tablet ![Compare how all Medicare Part D PDP plans in PA cover Delyla-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DEMECLOCYCLINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEMECLOCYCLINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DEMECLOCYCLINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEMECLOCYCLINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in PA cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days |
DEPO-PROVERA 400MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover DEPO-PROVERA 400MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | Q:1 /90Days |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in PA cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DESMOPRESSIN ACETATE 0.1 MG TB ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE 0.1 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days |
DESMOPRESSIN ACETATE 0.2 MG TB ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE 0.2 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in PA cover DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:25 /30Days |
DESOGESTR-ETH ESTRA 0.15-0.03MG ![Compare how all Medicare Part D PDP plans in PA cover DESOGESTR-ETH ESTRA 0.15-0.03MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOGESTR-ETH ESTRAD ![Compare how all Medicare Part D PDP plans in PA cover DESOGESTR-ETH ESTRAD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Desonide 0.0005 MG/MG Topical Ointment ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | None |
DESONIDE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DESONIDE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DESOXIMETASONE 0.25% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DESOXIMETASONE 0.25% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DESOXIMETASONE 0.25% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover DESOXIMETASONE 0.25% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Desvenlafaxine Succinate ER 100 mg [Pristiq] ![Compare how all Medicare Part D PDP plans in PA cover Desvenlafaxine Succinate ER 100 mg [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
Desvenlafaxine Succinate ER 25 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in PA cover Desvenlafaxine Succinate ER 25 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
Desvenlafaxine Succinate ER 50 mg tb [Pristiq] ![Compare how all Medicare Part D PDP plans in PA cover Desvenlafaxine Succinate ER 50 mg tb [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 0.5MG/0.5ML DROP ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG/0.5ML DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in PA cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days |
DEXILANT DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DEXILANT DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DEXMETHYLPHENIDATE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | 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 PA cover DEXMETHYLPHENIDATE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHETAMIN 20 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMP-AMPHETAMIN 30 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days |
DEXTROAMPHETAMINE 5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DEXTROAMPHETAMINE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:150 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA 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 |
$47.00 | $131.00 | Q:90 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
Dextrose 10%-water iv solution ![Compare how all Medicare Part D PDP plans in PA cover Dextrose 10%-water iv solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE 5%-0.45% NACL IV SOLN ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 5%-0.45% NACL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE 5%-0.9% NACL IV SOLN ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 5%-0.9% NACL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 5%-1/4NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 5%-1/4NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE 5%-WATER IV SOLN ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE 5%-WATER IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 1000ML X 12 CASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG ![Compare how all Medicare Part D PDP plans in PA cover DEXTROSE IN SODIUM CHLORIDE INJECTION 500ML X 24 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DIASTAT ACUDIAL 12.5-15-20 MG ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in PA cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in PA cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in PA cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover DIAZEPAM 5 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC 0.1% EYE DROPS [Voltaren] ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC 0.1% EYE DROPS [Voltaren].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICLOFENAC EPOLAMINE 1.3% PATCH TD12 [Flector] ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC EPOLAMINE 1.3% PATCH TD12 [Flector].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days |
DICLOFENAC SOD EC 25 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SOD EC 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DICLOFENAC SOD EC 50 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SOD EC 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SOD EC 75 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in PA cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
Diclofenac Sodium 1% gel ![Compare how all Medicare Part D PDP plans in PA cover Diclofenac Sodium 1% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
Diclofenac Sodium 3% gel ![Compare how all Medicare Part D PDP plans in PA cover Diclofenac Sodium 3% gel.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
diclofenac-misoprost 50-0.2 tablet ![Compare how all Medicare Part D PDP plans in PA cover diclofenac-misoprost 50-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
diclofenac-misoprost 75-0.2 tablet ![Compare how all Medicare Part D PDP plans in PA cover diclofenac-misoprost 75-0.2 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOXACILLIN SODIUM 500MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DICLOXACILLIN SODIUM 500MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in PA cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DIDANOSINE DR 200 MG CAPSULE DR [Videx EC] ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | Q:60 /30Days |
DIDANOSINE DR 250 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | Q:30 /30Days |
DIDANOSINE DR 400 MG CAPSULE [Videx EC] ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | Q:30 /30Days |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA 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 |
33% | N/A | Q:20 /10Days |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in PA cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIFLORASONE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover DIFLORASONE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIGITEK 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIGITEK 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIGITEK 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIGITEK 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DIGOX 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIGOX 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DIGOX 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIGOX 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in PA cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in PA cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in PA cover DIHYDROERGOTAMINE 4 MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:8 /30Days |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILANTIN-125 SUS 125/5ML ![Compare how all Medicare Part D PDP plans in PA cover DILANTIN-125 SUS 125/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DILTIAZEM 24HR ER 360 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 360 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24HR ER 420 MG CAP [Tiazac] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 24HR ER 420 MG CAP [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:30 /30Days |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in PA cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | 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 PA 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 |
$100.00 | $290.00 | 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 PA 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 |
$100.00 | $290.00 | None |
Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Diphenoxylate Hydrochloride and Atropine Sulfate 0.025; 2.5mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in PA cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | 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 PA 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 | $290.00 | 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 PA 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) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIPYRIDAMOLE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIPYRIDAMOLE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIPYRIDAMOLE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIPYRIDAMOLE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIPYRIDAMOLE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DIPYRIDAMOLE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DISULFIRAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DISULFIRAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in PA cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIVALPROEX DR 125 MG CAP SPRNK ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX DR 125 MG CAP SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DIVALPROEX SOD DR 125 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SOD DR 125 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SOD DR 250 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SOD DR 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DIVALPROEX SOD ER 500 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DIVALPROEX SOD ER 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIVALPROEX SODIUM ER TABLETS 250MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | 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 PA cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:240 /30Days |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in PA cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:120 /30Days |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in PA cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:60 /30Days |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days |
DORIPENEM 500 MG VIAL [Doribax] ![Compare how all Medicare Part D PDP plans in PA cover DORIPENEM 500 MG VIAL [Doribax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR ![Compare how all Medicare Part D PDP plans in PA cover DORZOLAMIDE HCL OPHTHALMIC 2% 10 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:10 /30Days |
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 PA 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 |
$7.00 | $0.00 | Q:10 /30Days |
DOVATO 50-300 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOVATO 50-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 1 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE 1 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DOXAZOSIN MESYLATE 2 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE 2 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DOXAZOSIN MESYLATE 4 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE 4 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DOXAZOSIN MESYLATE 8 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DOXAZOSIN MESYLATE 8 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | None |
DOXEPIN 10 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 10 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DOXEPIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in PA cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Doxercalciferol 0.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 0.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Doxercalciferol 1 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 1 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Doxercalciferol 2.5 mcg capsule [HECTOROL] ![Compare how all Medicare Part D PDP plans in PA cover Doxercalciferol 2.5 mcg capsule [HECTOROL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in PA cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in PA cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXYCYCLINE HYCLATE 100 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE HYCLATE 100 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE HYCLATE 50 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE HYCLATE 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE MONO 100 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 50 MG CAP ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in PA cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DROSPIRENONE-EE 3-0.02 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DROSPIRENONE-EE 3-0.02 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DROSPIRENONE-EE 3-0.03 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover DROSPIRENONE-EE 3-0.03 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUAVEE 0.45-20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover DUAVEE 0.45-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:30 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 20 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DULOXETINE HCL DR 30 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 30 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DULOXETINE HCL DR 40 MG CAPSULE DR [Irenka] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 40 MG CAPSULE DR [Irenka].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE DR [Cymbalta] ![Compare how all Medicare Part D PDP plans in PA cover DULOXETINE HCL DR 60 MG CAPSULE DR [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$17.00 | $0.00 | Q:60 /30Days |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DUTASTERIDE 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover DUTASTERIDE 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 [Jalyn] ![Compare how all Medicare Part D PDP plans in PA 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 | $290.00 | Q:30 /30Days |